Pamela Roach
Hastings,NE
Summary
Experienced Customer Experience professional with over 20 years in managing high call volumes and providing effective solutions. Skilled in engaging customers through open-ended questions to enhance satisfaction. Recognized for receiving positive feedback and actively contributing knowledge to improve team performance.
Overview
3
3
years of post-secondary education
22
22
years of professional experience
Work History
Customer experience specialist II
Principal Financial Group Inc
Grand Island, Nebraska
11.2015 - Current
- Reviewed hardship withdrawal requests from Principal customers, ensuring compliance with department procedures.
- Identify fraudulent documentation and escalate to proper channels.
- Resolved missing documentation issues while addressing participant inquiries across phone, email, and secure message channels.
- Documented customer interactions in Salesforce and case management systems.
Patient Financial Services Representative
Manhattan Surgical Hospital
Manhattan, KS
11.2013 - 08.2015
- Review medical claim denials and verify reasoning to determine the cause of denial before finding a resolution.
- Confirm that diagnosis codes and billing procedure codes are reasonable and appropriate before submitting claims to insurance.
- Accept patient phone calls readily to discuss bill, correct errors and apply payment to account.
- Call insurance companies for details on incorrect denials and claims lacking response in 30 days.
- Prepare secondary and tertiary claims for submission to additional payors.
- Verify remittance advice total charges, contractual adjustment and confirm balance belongs to patient before sending bill file to their party for statement mailing.
Patient Account Specialist
Geary Community Hospital
Junction City, KS
08.2008 - 04.2013
- Process patient payments and inquiries about balances owed to hospital and clinic.
- Identify patients who may qualify for state Medicaid. Interview at bedside to complete applications. Follow application and apply benefits for claim payment once approved.
- Guide patients through charity assistance applications. Process application.
- Maintain a list of charity approved families and adjust their bills per awarded discount or full write off.
- Review claim denials for accuracy and identify error denials for resolution.
- Review and work weekly credit balance report to correct, move payment or when appropriate refund payor for overpayments.
- 10 key proficiency gained.
Benefit Specialist
Principal Financial Group Inc
Grand Island, NE
02.2005 - 03.2006
- Verify benefits accurately.
- Claim review and explanation to a variety of insured or professional callers.
- Certify inpatient or other services requiring a prior auth.
- Answer frontline inbound medical & dental benefit and claim calls professionally.
- Utilize all resources, notes and procedures before contacting helpline.
- Maintain all performance metrics to meet or exceed requirements
Education
Associate of Applied Science - Computer Repair And Support
East Central Community College
Grand Island, NE 08.2001 - 05.2004
Skills
- Vast claims resolution and appeal experience across medical and dental insurance
- Claims processing
- High proficiency in Microsoft Office, billing and record keeping systems such as Salesforce
- Ten-key data entry
- Typing speed 80 wpm
- Professional telephone etiquette
- Pattern recognition
- Reading comprehension
- Tailored communication
Affiliations
- Camping, fishing and outdoor exploration
- Cold process soap making as a hobby
- Collect antique uranium glassware to display, sell and trade.
- Reading is a favorite activity in spare time
Timeline
Customer experience specialist II
Principal Financial Group Inc
11.2015 - Current
Patient Financial Services Representative
Manhattan Surgical Hospital
11.2013 - 08.2015
Patient Account Specialist
Geary Community Hospital
08.2008 - 04.2013
Benefit Specialist
Principal Financial Group Inc
02.2005 - 03.2006
Associate of Applied Science - Computer Repair And Support
East Central Community College
08.2001 - 05.2004