Miichel Rousseau
Houston,TX
Summary
Knowledgeable and dedicated customer service professional with extensive experience in health insurance industry. Solid team player with outgoing, positive demeanor and proven skills in establishing rapport with clients. Motivated to maintain customer satisfaction and contribute to company success. Specialize in quality, speed and process optimization. Articulate, energetic and results-oriented with exemplary passion for developing relationships, cultivating partnerships and growing businesses. Qualified Claims Representative versed in investigating claims, verifying information and managing settlements. Friendly and upbeat team player with organized and disciplined approach. Offering [Number] years of insurance experience.
Overview
12
12
years of professional experience
Work History
Central Claims Rep - Senior
Progressive
Houston, Texas
09.2021 - Current
- Interviewed policyholders to verify information and obtain additional details.
- Examined reports, accounts and evidence to determine integrity and accuracy of information.
- Worked productively in fast-moving work environment to process large volumes of claims.
- Followed up with customers on unresolved issues.
- Managed a high volume of claims files from start to finish
- Validate damage is consistent with the facts of the accident
- Independently make decision related to liability and coverage
Customer Care Advocate
CVS Health
Houston, TX
02.2019 - 09.2021
- Provided primary customer support to internal and external customers in fast-paced environment.
- Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
- Provided information to customers regarding claims and referrals to health care providers and offering solutions to problems via telephone, internet or written correspondence in production environment.
- Answered constant flow of customer calls with up to 50 calls in queue per minute.
- Collected customer feedback and made process changes to exceed customer satisfaction goal 97%.
- Evaluated account and service histories to identify trends, using data to mitigate future issues.
- Liaised with customers, management and sales team to better understand customer needs and recommend appropriate solutions.
- Effectively communicate with colleagues to meet deadlines and service metrics. Ability to be empathetic and compassionate. Following all privacy laws, i.e. HIPAA, PHI, PII and following CMS guidelines.
Provider Data Specialist
United HealthCare
Houston, TX
02.2017 - 02.2019
- Verified and enter contract details such as tax identification numbers, demographics & fee schedules via web based applications such as; Lara, IRS, NDB, NPI, Smart Front End, Enterprise Provider DataBase, etc.
- Administered, supported and monitored databases by proactively resolving database issues and maintaining servers.
- Planned and implemented security measures to safeguard vital business data.
- Coordinated with project management staff on database development timelines and project scope.
- Review contracts and agreements, performed necessary updates or terminations
- Practiced HIPAA compliance
- Verify Practitioners credentials such as: medical license numbers, TIN, NPI, DEA, board certified status, sanctions
- Increased database accuracy by 10%
Customer Care Professional
United HealthCare
Houston, TX
06.2015 - 02.2017
- Provided primary customer support to internal and external customers in fast-paced environment.
- Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
- Consistent HIPAA/PHI compliance
- Risk screen for high risk callers, create profiles and add clinician's information (tax id, billing address,NPI, license type) into database.
- Verifying patient's eligibility, coverage, explain & quote benefits for mental health and chemical dependency.
- Verifying healthcare clinician network status & reviewing/ensure claims processed correctly per Member's benefits.
- Clerical work utilizing copy/fax machines, daily clerical filing, submitting paperwork by dept. deadlines
- Examine billing/coding ICD 9/10 procedure codes for claims processing & verify claims submitted per timely filing guidelines
Customer Care Associate II
JCPenney Logistics
Milwaukee, WI
10.2013 - 12.2014
- Listened and engaged each customer making personal commitment for customer satisfaction.-Provide product knowledge increasing sales & customer loyalty.
- Track shipments, worked with delivery couriers scheduling deliveries, scheduling furniture repairs,exchanges
- Reviewed orders on case by case basis to determine appropriate compensation, coupon and price adjustments necessary
- Contributed to continuous improvement team-wide by collecting data on calls and giving managers knowledgeable feedback.
Customer Care Advocate II
Kohl's
Milwaukee, WI
10.2010 - 10.2013
- Educated customers on promotional offers and credit requirements to obtain credit account.
- Assisted customers with inquiries including account balance, credit line increases, available credit
- Assisted in new employee training, answered questions and helped associates with transitioning from training to production level environment
- Displayed patience, empathy and sincere eagerness to resolve issues and serve others
- Maintained 100% data entry accuracy
- Consistently met 98% customer satisfaction metrics
Collector II
Wells Fargo Home Mortgage
Milwaukee, WI
09.2009 - 09.2010
- Reached out to approximately 50 account holders daily.
- Monitored accounts for compliance with established payment plans and flagged those in violation.
- Practiced FDCPA compliance, knowledge of company products, policies, services and procedures
- Evaluated customers' financial situations, conducted skip tracing searches and/or collateral analysis by viewing credit bureau reports
- Screened Customer's for Home Affordability and FHA Loan Modification Programs in effort to stop Mitigation/Foreclosures
Education
No Degree - Nursing
Alverno College
MilwaukeeHigh School Diploma -
Riverside University High School
MilwaukeeSkills
- Report preparation
- Sales expertise
- International sales support
- Order fulfillment
- Complaint resolution
- Administrative support
- Creative problem solving
- Medical terminology knowledge
- Training development aptitude
- Good listening skills
- Data Entry
- Multi-line phone systems
- Microsoft Office Suite (Word, Excel, Power Point, Outlook)
- Insurance Verification
- HIPAA/PHI compliance
- Data Analysis
- Policy understanding
- Insurance coverage verification
- Insurance industry experience
- Excellent Communication
- Proficient in ClaimStation, Connect and PolicyPro
Timeline
Central Claims Rep - Senior
Progressive
09.2021 - Current
Customer Care Advocate
CVS Health
02.2019 - 09.2021
Provider Data Specialist
United HealthCare
02.2017 - 02.2019
Customer Care Professional
United HealthCare
06.2015 - 02.2017
Customer Care Associate II
JCPenney Logistics
10.2013 - 12.2014
Customer Care Advocate II
Kohl's
10.2010 - 10.2013
Collector II
Wells Fargo Home Mortgage
09.2009 - 09.2010
No Degree - Nursing
Alverno College
High School Diploma -
Riverside University High School