Paisley Foster
Mobile,AL
Summary
Customer-focused and detail-oriented member service chat with over 5 of experience delivering real-time support in healthcare and insurance environments. Skilled in resolving member inquiries related to benefits, claims, eligibility, and billing through live chat platforms with accuracy and empathy. Proven ability to multitask in fast-paced virtual settings, maintain HIPAA compliance, and meet performance metrics such as first-contact resolution and customer satisfaction. Adept at using CRM tools and member portals to provide efficient and accurate service, while ensuring a positive and supportive customer experience.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Member Service Chat Representative
UnitedHealth Group
01.2024 - Current
- Responded promptly and professionally to incoming member inquiries via live chat, ensuring a positive and helpful customer experience.
- Address concerns related to claims, coverage, benefits, eligibility, billing, and provider information using system tools and resources.
- Authenticated members and update account details accurately while following HIPAA and data privacy regulations.
- Consistently achieve key performance indicators such as chat response time, resolution rate, and customer satisfaction scores.
- Log all member interactions and resolutions in CRM systems with clarity and accuracy for future reference.
Medical Claims Representative
Mutual Of Omaha
11.2020 - 12.2023
- Delivers basic technical, administrative, or operative Claims tasks.
- Examines and processes paper claims and/or electronic claims.
- Completes data entry, maintains files, and provides support.
- Enhanced accuracy of processed claims with meticulous attention to detail and knowledge of coding systems.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Verified patient insurance coverage and benefits for medical claims.
Service Representative
CNC Catastrophe & National Claims
01.2019 - 11.2020
- Reviewed police reports, medical treatment records, and physical property damage to determine extent of liability.
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
- Reviewed questionable claims by conducting agent and claimant interviews to correct omissions and errors.
- Developed a comprehensive knowledge of product offerings to better assist customers with informed recommendations.
- Boosted sales revenue by identifying customer needs and recommending appropriate products or services.
Front Desk Receptionist
Premier Medical
08.2015 - 09.2018
- Greeted guests at front desk and engaged in pleasant conversations while managing check-in process.
- Maintained organized and clean front office area to create professional and welcoming environment for visitors and employees.
- Scheduled, coordinated and confirmed appointments and meetings.
- Delivered outstanding first impressions by warmly greeting visitors upon arrival at the front desk.
- Managed high-volume phone calls, directing inquiries to appropriate personnel for prompt resolution.
- Collected room deposits, fees, and payments.
- Scheduled appointments accurately using reservation software, reducing conflicts or doublebookings.
- Supported administrative tasks such as filing, data entry, and document preparation for more efficient office workflow.
Education
High School Diploma -
Murphy High School
Mobile, AL05.2013
Skills
- Persuasion techniques
- CRM software
- Empathy display
- Language fluency
- Quick typing
- Performance tracking
- Customer service
- Problem-solving
- Reliability
- Excellent communication
- Computer skills
- Customer service excellence
- HIPAA compliance
- ICD-10
- Policy interpretation
- Claims investigation
- Insurance coverage verification
- Policy review
- Billing software
- Coverage determination
- Eligibility determination
Certification
- Alabama
- Mississippi
- South Carolina
- Oregon
- Michigan
- Oklahoma
- Kentucky
- Montana
- West Virginia
- Maine
- Minnesota
Additional Information
Property and Casualty License
Alabama
Mississippi
South Carolina
Oregon
Michigan
Oklahoma
Kentucky
Montana
West Virginia
Maine
Minnesota
Timeline
Member Service Chat Representative
UnitedHealth Group
01.2024 - Current
Medical Claims Representative
Mutual Of Omaha
11.2020 - 12.2023
Service Representative
CNC Catastrophe & National Claims
01.2019 - 11.2020
Front Desk Receptionist
Premier Medical
08.2015 - 09.2018
High School Diploma -
Murphy High School
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