Paulette Edwards
Hawthorne,USA
Summary
Experienced with client relationship management and service optimization. Utilizes problem-solving skills to address client needs effectively. Strong understanding of communication and teamwork essential for improving customer satisfaction and more than 20 years of successful work experience.
Overview
25
25
years of professional experience
Work History
Premier Service Consultant (Mobility Sales Department)
AT&T Mobility Services LLC
10.2023 - Current
- Specialized in customer acquisition, sales, service and retention. Handle customer interactions (calls, chats, emails) in a fast-paced environment. Identify upselling opportunities and close deals to reach my sales and commission targets. Resolved issues related to service, billing, payments, and collections, ensuring customer satisfaction and retention. Explained bills and product features clearly. Troubleshot basic problems, including technical issues, and sought assistance from higher support. Provided solutions to prospective and existing customers to enhance their service experience, satisfaction and to keep loyal customers happy.
- Provided expert consultation on mobile services, enhancing customer satisfaction and loyalty.
- Analyzed customer needs to recommend tailored solutions, driving service improvements.
- Trained and mentored new staff on operational processes and best practices.
Member Service Advocate
Scan Health Plan
05.2018 - 08.2023
- Provided quality customer service, educated the members, family, friends, providers and caregivers regarding benefits and plan options in person, via email and by telephone. Serves members by being an advocate and point of contact for questions and concerns regarding benefits, eligibility, referrals, claims and any other aspects of plan benefits and services. Provides follow-up with members by clarifying the customers issue, determining the cause and identifying and explaining the solution. Escalates appropriate member issues to management or other departments as required. Consistently meeting and or exceeding the department standards.
Quality Management Coordinator
Delta Dental Plan of California
03.2015 - 01.2017
- Responsible for the handling of assigned appeals and grievances by inputting into appropriate databases, writing acknowledgement letters, obtaining dental records as needed, researching cases, resolving issues and mailing and faxing resolution letters and ensuring time frames are met for acknowledgement and resolution letters. Must comply with all regulatory requirements and policies of Delta Dental Plan of California. I answered telephone inquiries and maintained a professional level of telephone etiquette. Respond to any questions from the members, family members, authorized representatives, providers and others regarding appeals and grievances. Worked closely with internal departments to resolve and research member and provider reconsiderations, contacted members, providers and external agencies to obtain additional information to adequately resolve. Assists as needed in investigating member claims or billing discrepancies and coordinates with the Claims Department to successfully achieve corrective actions and resolution.
Correspondence Processor
Molina Healthcare
08.2014 - 09.2011
- Generate, process, track and store authorization requests and correspondence (electronic and hard copy) related to Care Access and monitoring approval and denials and other integrated Molina Healthcare programs including Behavioral Health and Long Term Care. Sort and file all inbound and outbound correspondence. Assist clinical staff with outbound faxing, data entry of member demographic and provider information updates, process and monitor all denial and CAM letters through Molina denial database and respond to and complete requests for correspondence as appropriate.
Customer Relations
Delta Dental Plan of California
11.2001 - 11.2010
- Provided excellent customer service to all members regarding their dental insurance eligibility information, answered benefit questions and I went over claim benefits with the members and the dental offices. I helped the member to find good dental practices to go to for services, processed payment for new and existing members and I sent our dental insurance mailing materials. Researched and responded to complex calls via telephone, emails and written inquiries regarding treatment plan questions, overcharging, refunds and I handled complaints, disputes and filed grievances for the members or dental practices. I enrolled members through employers, groups or brokers. Meet and maintain production standards, counts and inquiry response turnaround times. I answered between 75-120 calls per day.
Education
Dental Assisting - Dental Assisting And X-ray License
National Educational Center
Los Angeles, CA10-1987
No Degree - High School Studies
Alain Leroy Lock High School
Los Angeles, CA06-1986
Skills
- Microsoft Word, Excel, Outlook and Power Point
- Type 45-55 WPM
- Client relationship building
- Customer relations
- Complaint resolution
- Issue resolution
- Sales expertise
- Customer service
- Attention to detail
- Listening skills
- Multitasking and organization
- Handling customer complaints
- Data entry
Timeline
Premier Service Consultant (Mobility Sales Department)
AT&T Mobility Services LLC
10.2023 - Current
Member Service Advocate
Scan Health Plan
05.2018 - 08.2023
Quality Management Coordinator
Delta Dental Plan of California
03.2015 - 01.2017
Correspondence Processor
Molina Healthcare
08.2014 - 09.2011
Customer Relations
Delta Dental Plan of California
11.2001 - 11.2010
Dental Assisting - Dental Assisting And X-ray License
National Educational Center
No Degree - High School Studies
Alain Leroy Lock High School