Natasha Hayes
Piscataway,NJ
Summary
Knowledgeable and dedicated customer service professional experience in Health Insurance industry spanning 15 + years with extensive top-notch skills in oral and written communication, active listening and analytical problem-solving skills. Motivated to maintain customer satisfaction and contribute to company success.
Overview
28
28
years of professional experience
Work History
Customer Service Representative ll
Brighton Health Plan Solutions
New York, New York
04.2025 - Current
- Managed daily high-volume calls from members and providers regarding eligibility, benefits, and claims.
- Resolved complex claims issues, including denials, reprocessing, and appeals.
- Interpreted CPT/ICD codes, fee schedules, and EOBs to clarify claim outcomes.
- Consistently met or exceeded KPIs for call quality, average handle time, and first call resolution.
Referral Coordinator
Guide Health
Rockford, IL
12.2023 - 12.2024
- Facilitated referral and pre-certification inquiries for physician offices and providers.
- Collaborated with customer service, provider relations, and claims teams to resolve discrepancies.
- Accurately entered referrals and pre-certification calls into software program.
Membership & Enrollment Representative
Bright Health
Minneapolis, MN
08.2021 - 12.2022
- Provide level 1 support by answering incoming calls regarding Enrollment, Eligibility and Premium billing questions
- Work with State based Exchange and Federal Facilitated Marketplace to resolve level 1 Enrollment, premium, Advance premium tax credit disputes and discrepancies
- Ensure that all customer needs and problems properly communicated and managed to maintain great customer relationships.
Customer Service Representative
Cigna Health Care
Piscataway, NJ
01.2016 - 01.2021
- Managed calls from multiple accounts relating to medical benefits, claim payment status including billing disputes
- Assesses customers options on healthy lifestyle programs made recommendations according their needs
- Upheld Hippa privacy practices and company ethics/compliance requirements
- Actively participated in department developmental opportunities, self-study and other course work related to the healthcare industry.
Customer Service Advocate
QualCare Inc
Piscataway, NJ
07.2012 - 01.2016
- Answered questions for customers and providers on products, benefits, medical claims and eligibility
- Investigated medical claims for complete accuracy to determine appropriate action for claims processing
- Confirmed providers credentialing status and the actions needed to become an in-network or out of network provider
- Trained New employees on customer service script recitation and data entry practices.
Reservations Coordinator
LogistiCare
Edison, NJ
05.2011 - 07.2012
- Performed all gate keeping functions related to Medicaid patients that required transportation and vehicle ride assistance to and from medical facilities
- Scheduled routes and dispatches trips to third party vendors
- Ensure that vehicle resources used must efficiently and effectively meet the clients medical requirements.
Managed Care Coordinator
Horizon Blue Cross Blue Shield Of New
Jersey Newark, NJ
01.2006 - 04.2009
- Performs review of service requests for completeness of information, collection and transfer of non-clinical data and acquisition of structured clinical data from physicians and patients
- Handles initial screening for pre-certification requests from physicians and members via incoming calls or correspondence based on scripts and workflows and under the oversight of clinical staff
- Prepare, document and route cases in appropriate system for clinical review
- Reviewing professional medical claims policy related issues or claims in pending status
- Initiates call back or correspondence to physicians and members to clarify case completion.
Member Service Coordinator
Horizon Blue Cross Blue Shield Of New
Jersey Newark, NJ
09.1998 - 12.2005
- Promply responded to customer inquiries and resolved complaints to promote loyalty
- Initiate investigation process based on the inquiry claims, member information, benefits, enrollment and appeals
- AccAccurately document customer inquiries and actions taken in accordance with departmental quality guidelines to ensure appropriate follow up.
Education
Diploma - General Studies
West Side High School
Certificate Medical Billing And Coding -
Star Career Academy
Skills
- Ability to communicate clearly
- Active Listening Skills
- Empathy
- Positive Attitude
- Attention to Detail
Timeline
Customer Service Representative ll
Brighton Health Plan Solutions
04.2025 - Current
Referral Coordinator
Guide Health
12.2023 - 12.2024
Membership & Enrollment Representative
Bright Health
08.2021 - 12.2022
Customer Service Representative
Cigna Health Care
01.2016 - 01.2021
Customer Service Advocate
QualCare Inc
07.2012 - 01.2016
Reservations Coordinator
LogistiCare
05.2011 - 07.2012
Managed Care Coordinator
Horizon Blue Cross Blue Shield Of New
01.2006 - 04.2009
Member Service Coordinator
Horizon Blue Cross Blue Shield Of New
09.1998 - 12.2005
Diploma - General Studies
West Side High School
Certificate Medical Billing And Coding -
Star Career Academy