NOWELYN VERANCES
Waxahachie,TX
Summary
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
18
18
years of professional experience
Work History
MBB DMR Specialist
SCAN Health Plan
Long Beach, CA
06.2020 - Current
- Processed and reviewed claims for accuracy and compliance with regulations.
- Trained new team members on reimbursement policies and procedures effectively.
- Analyzed claim trends to identify areas for process improvement and cost reduction.
- Reduced errors in claims submissions for faster reimbursements by providing thorough training to new team members.
- Enhanced customer satisfaction by resolving claim disputes professionally and empathetically, addressing concerns promptly.
- Improved claim reimbursement processing times by streamlining workflows and implementing efficient documentation practices.
- Served as a mentor to junior staff members, providing guidance on best practices in claims processing and sharing valuable industry insights.
- Consistently met or exceeded performance metrics related to claims processing accuracy, timeliness, and customer satisfaction ratings.
- Strengthened relationships with key insurance stakeholders through clear communication channels and professional conflict resolution techniques.
- Conducted regular audits of processed claims to identify trends and areas requiring additional training or process improvements.
- Expedited claims resolution with diligent research and analysis of medical records, payment histories, and policy details.
MBB Representative Senior
SCAN Health Plan
Long Beach, CA
04.2017 - 06.2020
- Implemented quality control measures to reduce errors in billing processes and enhance customer satisfaction.
- Reviewed and solved account and billing discrepancies.
- Identified, researched, and resolved billing variances to maintain system accuracy and currency.
- Leveraged strong analytical skills to identify patterns in data, enabling accurate forecasting and improved decisionmaking.
- Enhanced client satisfaction with prompt resolution of billing inquiries and disputes.
- Researched and resolved billing discrepancies to enable accurate billing.
Member Service Representative Senior
SCAN HEALTH PLAN
Long Beach, CA
12.2014 - 04.2017
- Trained and mentored new team members on best practices for member services and support tools.
- Improved member satisfaction by promptly addressing inquiries and providing accurate information.
- Resolved escalated member issues with diplomacy, tactfully navigating challenging situations while maintaining rapport with the customer.
- Developed strong relationships with members by providing personalized support and assistance.
- Handled sensitive member information responsibly, adhering strictly to privacy regulations and guidelines.
- Served as a subject matter expert for colleagues seeking guidance on policy intricacies or problem-solving strategies.
Member Service Representative
SCAN Health Plan
Long Beach, CA
04.2014 - 12.2014
- Provided exceptional customer service to members, addressing inquiries and resolving issues efficiently.
- Educated members on plan benefits and services, ensuring clear understanding of options available.
- Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
- Enhanced customer satisfaction by efficiently addressing and resolving inquiries and concerns.
- Maintained high-quality service by adhering to company policies and standards in all member interactions.
- Verified customer identification and documentation for compliant transactions.
- Assisted members with account management, including updating personal information and setting up automated payments.
- Handled complaints with prompt, courteous service to uphold professional reputation.
Agency Service Executive (Allstate Insurance, USA)
EXL Services Philippines Inc.
Pasay, NCR, Philippines
09.2011 - 09.2013
- Handle exclusive Allstate agency staff inquiries regarding Insured’s Policy, complaints, billing questions, payment extension/service requests, endorsement/changes in the policy, claims information, accidents and violations impact in the premium. Calm angry callers, repair trust, locate resources for problem resolution and design best-option solutions.
- Key Accomplishments:
- Managed a high-volume workload within a deadline-driven environment. Resolved an average of 300 inquiries in any given week and consistently met performance benchmarks in all areas (speed, accuracy, volume).
- Became the lead “go-to” person for new reps and particularly challenging calls as one of the company’s primary mentors/trainers of both new and established employees.
- Helped company attain the highest customer service ratings (as determined by external auditors) – earned 100% marks in all categories including communication skills, listening skills, problem resolution and politeness.
- Awarded as most number of 100% Agent Surveys in 2 days.
- Officially commended for initiative, enthusiasm, tenacity, persuasiveness, intense customer focus and dependability in performance evaluations.
- Completed voluntary customer service training to learn ways to enhance customer satisfaction and improve productivity.
Team Leader/Operation Supervisor (T-Mobile USA)
Teletech Holdings Inc.
Iloilo, Philippines
06.2008 - 07.2010
- Handle 17-20 agents in a team. Analyze call volume and average call time to monitor Customer Service Representative’s performance and productivity. Escalate issues which cannot be resolved by the Team. Provide team leadership and Coaching by creating an environment oriented to trust, open communication, creative thinking, and cohesive team effort.
- Key Accomplishments:
- Highly commended for 10 –15 % increase in Team’s Reliability in a month.
- Team has been included in top ten with highest Quality Score out of 55 teams in the whole site.
- Most Improved Team in lowering AHT (Average Handling time and ACW (after call work) scores in 3 months.
Customer Service Representative (T-Mobile USA)
Teletech Holdings Inc.
Iloilo, Philippines
01.2008 - 06.2008
- Handle incoming calls from account holders, responding to inquiries, troubleshooting handsets and devices, processing payments, resolving problems and correcting account errors.
- Key Accomplishments:
- Chosen as one of the “Subject Matter Expert” (15 SME out of 400 agents) in 2007. Ranking was based on accuracy, internal and clients survey score, customer service, duration of calls and availability.
- Perfect 100% Reliability Score.
- Promoted as Team Leader/Operation Supervisor in 5 months prior to job regularization.
Education
Bachelor of Science - Fisheries Business Management
University of The Philippines
Iloilo, Philippines04-2007
Skills
- Customer service expertise
- Customer service operations expertise
- Complaint resolution expertise
- Data management expertise
- Proficient in multiline phone systems
- Intermediate Outlook experience
Timeline
MBB DMR Specialist
SCAN Health Plan
06.2020 - Current
MBB Representative Senior
SCAN Health Plan
04.2017 - 06.2020
Member Service Representative Senior
SCAN HEALTH PLAN
12.2014 - 04.2017
Member Service Representative
SCAN Health Plan
04.2014 - 12.2014
Agency Service Executive (Allstate Insurance, USA)
EXL Services Philippines Inc.
09.2011 - 09.2013
Team Leader/Operation Supervisor (T-Mobile USA)
Teletech Holdings Inc.
06.2008 - 07.2010
Customer Service Representative (T-Mobile USA)
Teletech Holdings Inc.
01.2008 - 06.2008
Bachelor of Science - Fisheries Business Management
University of The Philippines