MIANTE ENGLISH
Tampa,FL
Summary
Pragmatic Insurance Verification Specialist touting 5 years of expertise in benefits explanation and coverage tracking. A team player with a vast knowledge of medical terms and working with all types of personalities effectively. Offering dynamic organizational skills and attention to detail.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Medicare Member Services Representative
Florida Blue
Tampa, FL
08.2023 - Current
- Review Medicare members' enrollment or claims history ensuring accuracy of billing and enrollment and application of deductible and member responsibility
- Investigate Medicare claims and obtain additional evidence and documentation if necessary
- Authenticate callers to ensure we are following Hipaa Disclosure laws
- Ensure members are following cms guidelines for their health coverage by maintaining applicable coverage limits
- Identify, researched, documented, and resolved appeals and grievances expressed orally or written by members
- Analyze procedure codes, revenue codes, and diagnosis codes for authorizations, services rendered, and treatment plans
- Receive and process claims, negotiate billing with providers, and determine the cost share for members.
Customer Service Specialist
Progressive Insurance
05.2019 - 08.2023
- Conferenced with customers regarding their insurance needs over the phone
- Ensured each policy is following the underwriting requirements for the company as well as meeting the state requirements per the department of insurance
- Identified unresolved concerns such as offers for homeowners and or commercial coverage
- Assisted with billing needs as well as process request for debt write offs
- Determined if coverage is applicable to start the claims process.
Customer Relations Specialist
Alorica
11.2013 - 02.2019
- Conferred with customers by telephone and email to provide information about products or services, entered orders, canceled accounts, and obtained details of complaints
- Interfaced with brokerage agents through a customs portal that allowed us to view different commodities for approval
- Reviewed international import and export compliance procedures
- Completed detailed data entry reports for customs breaking down the intent of commodities and their overall acceptability
- Advised customers on how to properly fill out customs paperwork
- Handled unresolved customer grievances and complete claim investigations to ensure the customer gets the proper resolution
- Trained new agents on the international call flow
- Supervised calls remotely as well as one on one for quality and provided feedback for growth.
Internship
Miracles Outreach
06.2018 - 08.2018
- Conducted assessments to attain the level of safety and risk factors for each child
- Created the curriculum for the week as well as came up with topics for reflection
- Intervened when there was an issue of conflict and acted as the mediator to ensure the issue was deceased
- Provided food as well as hygiene products for families in the community.
Internship
Echo community outreach
05.2018 - 06.2018
- Assessed client's needs for service
- Enlightened the client of the services offered
- Appointed referrals for anyone that was not within the service area
- Reviewed notes entered in the Unity system for the client.
Internship
Metropolitan Ministries
01.2018 - 05.2018
- Assessed client's needs for service
- Informed the client of the services offered
- Provided referrals for anyone that did not meet the agencies requirements
- Administered vouchers for clients who needed assistance financially
- Review notes entered in the Unity system for the client
- Collaborated with clients to discuss the steps that got them to Metropolitan Ministries
- Established care plans to ensure clients are on the correct path for treatment
- Briefed the clients of the available resources and monitored to ensure they followed the budget for items
- Assessed for any medical concerns and provided proper resources for health care coverage and/or affordable care providers.
Internship
Centre 4 Girls
08.2017 - 12.2017
- Assisted at the front desk and answer questions about the program and the cost to attend
- Facilitated group activities between the parents and the students to keep them involved in the program
- Created the curriculum for the week as well as came up with topics for reflections
- Intervened when there was an issue of conflict and acted as the mediator to ensure the issue was resolved peacefully.
Child Care Provider
A Learning Space Academy
11.2012 - 11.2013
- Organized and lead activities designed to promote physical, mental and social development
- Taught basic skills such as color, shape, number and letter recognition, personal hygiene, and social skills
- Groomed infants and kept records of changing times and feeding times
- Documented any areas of concern that were observed by myself or other staff.
Sales Associate
Lids Locker Room
07.2012 - 11.2013
- Described merchandise and explained the use and care of merchandise to customers
- Computed sales prices, totaled purchases and processed cash and/or credit payment
- Watched for and recognized security risks and thefts, and how to prevent and handle these situations
- Inventoried stock and requisitioned new stock.
Education
Associates in science -
Hillsborough Community College
01.2018
Skills
- Quality audits
- Certified in CPR
- Microsoft Word
- Power point certified
- Microsoft excel certified
- Attained Unity training
- HIPAA certified
- Human trafficking certification
- Domestic violence certification
- Certified Food Manager
- 10 years of customer service experience
- Computer literate
- ICD-9 Familiarity
- Data entry
- Medical terminology
- Typing speed 65wpm
- ICD-10 Familiarity
- Time management
- Ability to manage multiple tasks simultaneously
- Detail oriented
- Strong organizational, interpersonal, and communication skills
Certification
CPR Certification
Timeline
Medicare Member Services Representative
Florida Blue
08.2023 - Current
Customer Service Specialist
Progressive Insurance
05.2019 - 08.2023
Internship
Miracles Outreach
06.2018 - 08.2018
Internship
Echo community outreach
05.2018 - 06.2018
Internship
Metropolitan Ministries
01.2018 - 05.2018
Internship
Centre 4 Girls
08.2017 - 12.2017
Customer Relations Specialist
Alorica
11.2013 - 02.2019
Child Care Provider
A Learning Space Academy
11.2012 - 11.2013
Sales Associate
Lids Locker Room
07.2012 - 11.2013
Associates in science -
Hillsborough Community College