Monique Williams
Philadelphia,PA
Summary
Gifted in working with stressed, confused and upset individuals in need of benefits information and supportive guidance to navigate web portal. With over 10 years of experience in Customer Service bringing top-notch skills in oral and written communication, active listening and analytical problem-solving skills. Enhances customer experiences by employing service-oriented behaviors, understanding customer desires and providing customized solutions to build loyalty. Knowledgeable about preparing invoices, processing payments and pursuing past-due balances. Well-versed in accurately coding different types of bills for clear recordkeeping and tracking. Team-oriented, dependable and performance-driven.
Overview
15
15
years of professional experience
Work History
Claims Specialist
UnitedHealth Group
Horsham, PA
11.2020 - 05.2023
- Reviewed, researched, analyzed and process complex healthcare claims by navigating multiple computer systems and platforms and accurately capturing data/information for processing.
- Followed claim procedures, state mandates, CMS/Medicare guidelines, benefit plan documents.
- Replaced and void claim checks for insured members and providers.
- Educated providers on processed or reprocessed claims and help navigate provider website portal.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Managed up to 30 customer calls per day.
Medicare Member Help Team
Independence Blue Cross
Philadelphia, PA
10.2017 - 12.2019
- Assisted Brokers and Group administrators, enrolling medical plans for small group of 2-50 employees and large group businesses more than 50 employees.
- Assisted in resolving billing, Rx claims and medical claim issues as needed.
- Adhere to corporate policies/procedures; remain current on department and industry regulations.
- Educated members on Medical, Vision, Dental, and Prescription Medicare plans.
- Scheduled informational meetings for members to discuss Medicare plan options.
- Developed and maintained courteous and effective working relationships.
Special Project Team Member
Independence Blue Cross
Philadelphia, PA
03.2017 - 10.2017
- Researched on member issues that was with company.
- Monitored project progress, identified risks and took corrective action as needed which helped company improve First Call Resolution to 94%.
- Forward appropriate request to operating areas to accomplish action required as result of inquiry.
- Collaborated ideas on how to improve First Call Resolution.
- Assisted in level-loading project capacity and made proactive decisions around process improvements to development cycle.
Customer Service Trainer
Independence Blue Cross
Philadelphia, PA
12.2016 - 02.2017
- Call monitored live and recorded calls between members and associates.
- Facilitated associates how to get through calls during high call volume.
- Collaborated with staff members to enhance customer service experience and exceed team goals through effective client satisfaction rates.
- Reduced process inconsistencies and effectively trained team members on best practices and protocols.
- Conducted customer service training sessions for new team of 25-30 employees.
Billing Analyst
Independence Blue Cross
Philadelphia, PA
06.2016 - 12.2016
- Processed payments for reinstatement request.
- Worked with multiple departments to check proper billing information.
- Assisted with over 30 or more billing inquiries per day and provided timely responses to enhance customer satisfaction.
- Analyzed payment information and applied changes correct customer accounts.
- Researched and resolved billing discrepancies to enable accurate billing.
Escalations Specialist
Independence Blue Cross
Philadelphia, PA
01.2016 - 05.2016
- Handled over 50 escalated inbound/outbound calls per day in fast-paced environment.
- Created Q&A booklet for associates to handle calls appropriately before escalated.
- Investigated and resolved customer inquiries and complaints quickly.
- Followed up with customers about resolved issues to maintain high standards of customer service.
- Monitored and analyzed customer feedback to track patterns in feedback and report areas for improvement to management.
Customer Service Representative
Independence Blue Cross
Philadelphia, PA
02.2015 - 12.2015
- Resolving billing, enrollment, and payment disputes on behalf of clients whose issues impacted over 30-day aging.
- Promoted superior experience by addressing customer concerns, demonstrating empathy, and resolving problems swiftly.
- Processed Reinstatement requests on terminated accounts.
- Educated medical benefits to insured members.
- Participated in team meetings and training sessions to stay informed about product updates and changes.
- Maintained average handle time under 7 minutes.
- Developed and updated databases to handle customer data.
Billing Representative
Contemporary Staffing Solutions
Philadelphia, PA
07.2014 - 01.2015
- Educate members on billing process.
- Reviewed and solved account and billing discrepancies.
- Worked with multiple departments to check proper billing information.
- Processed and verified invoices to secure accuracy of billing information.
- Received over 50 incoming call information and entered into database system.
Collection Representative
NCO Financial Systems
Philadelphia, PA
04.2008 - 12.2013
- Established relationships with customers to encourage payment of delinquent accounts.
- Located customers with overdue accounts and solicited payment in compliance with fair debt collection practices.
- Deployed automated system tracking and skip tracing to locate hard-to-find, re-located customers, managed over 100 customer calls per day.
Education
High School Diploma -
Germantown High School
Philadelphia, PA06.2006
Skills
- Team Player
- Basic Medical Terminology
- Advanced analytical skills
- Ability to handle multiple task
- Ability to problem solve and prioritize
- Extensive Call Center/Operations experience
- Microsoft Office
- Premium Calculations
- Complex Problem-Solving
- Organization and Prioritizing Tasks
- Payment and Investigation Escalations
- Insurance Terminology
- Active Listening
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Quote
Don’t judge each day by the harvest you reap, but by the seeds you plant.
Robert Louis Stevenson
Timeline
Claims Specialist
UnitedHealth Group
11.2020 - 05.2023
Medicare Member Help Team
Independence Blue Cross
10.2017 - 12.2019
Special Project Team Member
Independence Blue Cross
03.2017 - 10.2017
Customer Service Trainer
Independence Blue Cross
12.2016 - 02.2017
Billing Analyst
Independence Blue Cross
06.2016 - 12.2016
Escalations Specialist
Independence Blue Cross
01.2016 - 05.2016
Customer Service Representative
Independence Blue Cross
02.2015 - 12.2015
Billing Representative
Contemporary Staffing Solutions
07.2014 - 01.2015
Collection Representative
NCO Financial Systems
04.2008 - 12.2013
High School Diploma -
Germantown High School
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