Monica Francis Rivers
Missouri City,TX
Summary
Proactive and goal-oriented professional with excellent time management and problem-solving skills. Known for reliability and adaptability, with swift capacity to learn and apply new skills. Committed to leveraging these qualities to drive team success and contribute to organizational growth.
Overview
11
11
years of professional experience
Work History
Virtual Call Center Customer Service Representative
Independence Blue Cross, LLC
10.2022 - Current
- Answers high volume inbound calls from members, providers, and other plans aiding with health insurance plan details, claim status, billing inquiries, and eligibility verification.
- Resolve complex issues, including claim denials, benefit discrepancies, billing errors, and provider access concerns.
- Educate customers on plan benefits, claim submissions, online portals, and key policy terms.
- Ensure compliance with program guidelines, HIPAA regulations, and company policies.
- Demonstrate strong multitasking skills by navigating systems, documenting calls, and resolving issues simultaneously.
- Improve resolution times through efficient problem-solving and clear communication.
- Has worked in multiple departments within the organization, gaining well-rounded experience in customer service and healthcare support:
- Small Group Department: Handled member services assisted members directly with their health plan inquiries.
- Federal Employee Program (FEP): Supported members and healthcare providers enrolled in the FEP insurance plan, addressing their federal insurance inquiries.
- Plan-to-Plan Department: Provided customer service support to other Blue Cross Blue Shield Plans.
School Registrar
Randstad – Stride IQN K12
10.2021 - 04.2022
- Maintained accurate student records through diligent monitoring and data entry, ensuring compliance with state and federal regulations.
- 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.
- Verified accurate student records by thoroughly reviewing and updating information in the database.
Special Education Resource Paraprofessional
Fort Bend ISD
08.2018 - 06.2021
- Assisted in the creation of engaging and accessible instructional materials, ensuring all students could participate in lessons effectively.
- Enhanced student learning experiences by implementing individualized educational plans tailored to unique needs.
- Verified accurate student records by thoroughly reviewing and updating information in the database.
- Managed sensitive student information with utmost confidentiality, building trust within academic community.
- Monitored student progress through regular assessments and updated individualized education plans accordingly.
- Interacted physically and verbally with students throughout each day.
Patient Services Rep II
Sutherland Global Services – VA Choice Program
10.2014 - 03.2016
- Maintained patient confidentiality by adhering to HIPAA regulations and diligently updating records as needed.
- Resolved patient complaints promptly, demonstrating empathy and understanding while seeking mutually beneficial solutions.
- Processed authorizations, reviewed medical documentation for accurate coding and claim submission, scheduled appointments.
- Verified the credentials of the providers to ensure they met the qualifications standards and regulations of the Veteran's Choice Program.
Education
MBA - Healthcare Management
Colorado Technical University
Colorado Springs, CO06.2009
BBA - Healthcare Management
American Intercontinental University
Buckhead, GA09.2005
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 - Current
School Registrar
Randstad – Stride IQN K12
10.2021 - 04.2022
Special Education Resource Paraprofessional
Fort Bend ISD
08.2018 - 06.2021
Patient Services Rep II
Sutherland Global Services – VA Choice Program
10.2014 - 03.2016
MBA - Healthcare Management
Colorado Technical University
BBA - Healthcare Management
American Intercontinental University
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