Monica Francis Rivers
Missouri City,TX
Summary
Experienced with managing customer interactions and providing effective solutions. Utilizes communication and problem-solving skills to address customer concerns promptly. Knowledge of fostering positive customer relationships and maintaining high service standards.
Overview
11
11
years of professional experience
Work History
Virtual Call Center Customer Service Representative
Independence Blue Cross, LLC
10.2022 - 04.2025
- Answered inbound customer calls from FEP members, aiding with health insurance plan details, claim status, billing inquiries, and eligibility verification
- Resolved complex issues, including claim denials, benefit discrepancies, billing errors, and provider access concerns
- Educated customers on plan benefits, claims submission, online portals, and key policy terms
- Ensured compliance with FEP program guidelines, HIPAA regulations, and company policies when handling sensitive customer information
- Maintained accurate records by documenting customer interactions and updating account information in the system
- Served as a liaison between members, providers, vendors, and other BCBS Plans to facilitate seamless customer support
- Demonstrated excellent multitasking abilities by simultaneously handling multiple tasks such as navigating systems, taking notes on calls, and answering inquiries from clients.
- Reduced call resolution time through efficient problem-solving and communication skills.
Registrar (Customer Support & Data Entry)
Randstad – Stride IQN K12
10.2021 - 04.2022
- Managed student enrollment, transfers, and withdrawals, ensuring timely and accurate data updates
- Verified and corrected data discrepancies to maintain compliance with institutional policies
- Processed high-volume data entry with a focus on precision and efficiency
- Organized, reviewed, and filed paperwork for secure recordkeeping.
- Ensured accurate student records by diligently maintaining and updating information in the database.
- Verified paperwork accuracy and checked for completion prior to processing.
- Reduced errors in transcript processing through careful attention to detail while entering grades into the system.
- Managed sensitive student information with utmost confidentiality, building trust within academic community.
Patient Services Representative II
Sutherland Global Services – VA Choice Program
10.2014 - 03.2016
- Assisted veterans with healthcare services, including scheduling medical appointments and processing authorizations
- Provided clear and concise explanations of benefits, policies, and claim procedures
- Reviewed and processed medical documentation and insurance claims for accuracy and completeness
- Maintained compliance with HIPAA and company regulations while handling confidential patient data
- Maintained patient confidentiality by adhering to HIPAA regulations and diligently updating records as needed.
- Managed high call volume, prioritizing urgent issues and directing calls appropriately for optimal resolution.
- Resolved patient complaints promptly, demonstrating empathy and understanding while seeking mutually beneficial solutions.
Education
Bachelor of Business Administration - Healthcare Management
American Intercontinental University
Georga09.2005
Skills
- Health Insurance & Claims Processing
- Customer Service & Issue Resolution
- Policy & Benefit Explanation
- Data Entry & Recordkeeping
- Compliance & HIPAA Regulations
- CRM & Insurance Software Navigation
Timeline
Virtual Call Center Customer Service Representative
Independence Blue Cross, LLC
10.2022 - 04.2025
Registrar (Customer Support & Data Entry)
Randstad – Stride IQN K12
10.2021 - 04.2022
Patient Services Representative II
Sutherland Global Services – VA Choice Program
10.2014 - 03.2016
Bachelor of Business Administration - Healthcare Management
American Intercontinental University
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