POOJA KARKI
Aurora,CO
Summary
An agile individual with excellent communication and customer service skills. Results-driven Membership Representative accomplished in bringing in new customers and maximizing revenue. Well-versed in different insurance plans and competitor offerings. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy. Knowledgeable Membership Representative offering over three years of expertise in handling a multitude of daily issues with exceptional poise. A bilingual individual known for collaborating with highly successful teams and embracing methods and approaches that drive business opportunities. Promoting exemplary skills in scheduling, engaging new and existing members, and building lasting relationships.
Overview
10
10
years of professional experience
Work History
Membership Representative II
Elevance Health (Anthem BCBS Formerly)
01.2020 - Current
- Maintained membership database, ensuring that all information was current and accurate.
- Helped customers navigate choices between services with support for questions such as terms, pricing, and availability.
- Promoted a high level of customer satisfaction using strong relationship-building skills, consistent follow-up, and prompt issue resolution.
- Respond to incoming calls and may initiate outgoing calls, providing customer service to plan members, providers, and employer groups by answering benefit questions, resolving issues, and educating callers.
- Ensure accuracy and timeliness of membership and billing functions and respond to inquiries concerning enrollment processes.
- Notified clients of premium discrepancies through payment adjustment notices and detailed audits.
- Maintained enrollment database and determined eligibility and applied contract language for each case assigned.
- Used CRM software to record customer interactions and track general sales activities for review and follow-up
- Identified issues and immediately stepped up to guarantee speedy and effective resolutions
Membership Enrollment Representative
Anthem Blue Cross Blue Shield, Aerotek (Contract)
08.2019 - 01.2020
- Responsible for enrollment, billing activities, and/or maintaining assigned accounts
- Respond to incoming calls and may initiate outgoing calls
- Providing service to employer groups, brokers, and other internal and external customers by answering benefit questions, resolving issues, and educating callers
- Verifying enrollment status, making changes to records, researching and resolving enrollment system rejections
- Respond to inquiries concerning enrollment processes
- Determining eligibility and applying contract language for each case assigned
- Thoroughly document inquiry outcomes for accurate tracking and analysis
- Develop and maintain positive customer relations and coordinate with various functions within company to ensure customer requests and questions are handled appropriately and in timely manner
- Experience with FACETS, IngenioRx, and BPM
- Worked with sales team to collaboratively reach targets, consistently meeting or exceeding personal quotas.
- Conducted annual reviews of existing policies to update information.
- Monitored customer feedback and identified areas of improvement.
- Maintained detailed and accurate records between multiple databases and programs.
- Investigated issues and created solutions for new customers.
- Analyzed customer needs to provide customized insurance solutions.
- Educated clients on insurance policies and procedures.
ESL Teacher, Independent Contractor
VIPKID
12.2017 - 06.2019
- ONLINE
- Implicate VIPKid’s curriculum on online platform to students aged four to twelve living in China
- Provide 1-on-1 classes
- Teaching lessons using interactive PowerPoint
- Provide feedback to parents and other educators at conclusion of each lesson to enhance student outcomes
- Use various online learning tools besides interactive platforms to provide fun and entertaining learning environment
- Administer and grade tests on regular basis to evaluate student progress and identify areas that need further improvement.
- Educated students in basics of English grammar and conversational speaking.
- Developed and taught ESL curriculum to improve students' conversational abilities.
- Coached students on English pronunciation and intonation for eloquent conversation.
- Set assessments to measure student progress and identify growth opportunities.
- Attended workshops to learn about student motivation and engaging learning activities.
- Created and delivered engaging lesson plans to accommodate different learning styles.
- Increased ESL students' reading levels by integrating online word games and altering lesson plans for students needing extra guidance.
- Gave one-on-one attention to each student while maintaining overall focus on entire group.
- Developed activities and integrated technology to diversify instruction.
- Adopted new technologies and online platforms to facilitate student learning.
Medical Support Assistant
Department of Veterans Affairs
12.2015 - 02.2016
- Responsible for effective and efficient patient appointment scheduling for one or more VA outpatient clinics
- Act as liaison between veterans and their providers, healthcare personnel, and scheduling company
- Entering veteran’s information into VISTA program and updating into Computerized Patient Record System (CPRS)
- Solving problems, issues, concerns of veterans regarding their Healthcare benefits and appointment scheduling
- Provide timely assistance to veterans with their Healthcare related issues
- Maintaining records of Patients and tracking progress
- Performing regular and daily follow up on patient’s activities and scheduling appointments
- Updating and Uploading required documents into healthcare system through DOMA
- Maintaining a high level of coordination and scheduling competencies learned through TMS module to avoid patients having to make multiple trips to medical center or clinic whenever possible.
Business Analyst
T3 Resources
08.2015 - 12.2015
- Worked in Agile environment for high-visibility product
- Collaborated regularly with Product Owner, Project Manager, and actual users in gathering requirements
- Held interviews and JAD sessions while collecting requirements details
- Created, reviewed, and analyzed detailed User Stories for all requirements
- Developed flow charts as per non-technical information collected during requirement-gathering phase
- Uploaded user stories into Agile Project Management tool, JIRA, and Spira Test
- Created detailed wireframes using Balsamiq Wireframing tool and MS Visio
- Participated in daily scrum meetings and worked with Project Manager regarding project-specific information such as schedule, issues and risks any other related information
- Held meetings and demos for Testing Team regarding requirements and wireframes
- Worked closely with QA team in coordinating project schedules, explaining requirements, and answering any question team members would have regarding features being developed
- Maintained Product Backlogs and coordinated with product manager in prioritizing user stories
Production Specialist
Jeppesen; A Boeing Company
06.2014 - 12.2014
- Inserting and assembling flight manuals in accordance with work instructions
- Know and use checklists and work instructions to ensure quality of assembled materials
- Preparing materials for routine shipment
- Performing quality checks on assembled materials.
Handbook Assembler
Jeppesen Sanderson Inc, Excel Personnel Inc
10.2013 - 06.2014
- Inserting and assembling flight manuals in accordance with work instructions
- Know and use checklists and work instructions to ensure quality of assembled materials
- Preparing materials for routine shipment
- Performing quality checks on assembled materials.
Education
Bachelor of Science - Business Administration and Management
10.2016
Bachelor of Business Studies - Finance
2005
Skills
- Membership policies and procedures
- Representative experience
- Membership management
- Membership retention
Additional Information
- Dean’s List: Business Administration, Department Columbia College, Aurora, Colorado 2009
- Certificate of completion Business Analysis Training, Dec 2014-June 2015
Languages
English
Full Professional
Hindi
Full Professional
Nepali
Native or Bilingual
Timeline
Membership Representative II - Elevance Health (Anthem BCBS Formerly)
01.2020 - Current
Membership Enrollment Representative - Anthem Blue Cross Blue Shield, Aerotek (Contract)
08.2019 - 01.2020
ESL Teacher, Independent Contractor - VIPKID
12.2017 - 06.2019
Medical Support Assistant - Department of Veterans Affairs
12.2015 - 02.2016
Business Analyst - T3 Resources
08.2015 - 12.2015
Production Specialist - Jeppesen; A Boeing Company
06.2014 - 12.2014
Handbook Assembler - Jeppesen Sanderson Inc, Excel Personnel Inc
10.2013 - 06.2014
Columbia College - Bachelor of Science, Business Administration and Management
St. Xavier’s College - Bachelor of Business Studies, Finance
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