Summary
Overview
Work History
Education
Skills
Certification
Additional Information
Assessments
Personal Information
Work Authorization
Awards
Reading, painting, bullet journaling
Timeline
Generic
Rachel James

Rachel James

Member Advocate
Toledo,OH

Summary

To secure a long term, stable position within a company that appreciates the commitment & knowledge will bring to role. Personable customer service offering 10 plus years of experience resolving account and service concerns for customers. Smoothly uncovers and solves challenges while promoting company products and maintaining loyal, satisfied customers. Focused on surpassing expectations and driving team success. Knowledgeable and dedicated customer service professional with extensive experience in medical industry. Solid team player with outgoing, positive demeanor and proven skills in establishing rapport with clients. Motivated to maintain customer satisfaction and contribute to company success. Specialize in quality, speed and process optimization. Articulate, energetic and results-oriented with exemplary passion for developing relationships, cultivating partnerships and growing businesses.

Overview

10
10
years of professional experience
1
1
Certification

Work History

Member Services Representative

CVS/AETNA
Toledo, OH
10.2021 - Current
  • Answer incoming member calls providing assistance on account benefits, MSO information, claim information if needed settling discrepancies by calling provider billing, checking status with Medicare & Social Security, providing proper department transfer if needed.
  • Learned internal systems and related service role duties to provide skilled team backup in handling customer demands.
  • Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
  • Assisted members with correcting account, service, and system issues by educating on required forms and technical processes.
  • Learned and maintained in-depth understanding of product and service information to offer knowledgeable and educated responses to diverse customer questions.
  • Handled complaints with prompt, courteous service to uphold professional reputation.
  • Developed, implemented and collated customer satisfaction surveys for improved insight.
  • Verified customer identification and documentation for compliant transactions.
  • Maintained and managed customer files and databases.
  • Maintained updated knowledge of internal processes and industry best practices to optimize service delivery.
  • Resolved customer issues through thorough dispute investigation.
  • Responded to customer calls and emails to answer questions about products and services.
  • Sought ways to improve processes and services provided.
  • Collaborated with staff members to enhance customer service experience and exceed team goals through effective client satisfaction rates.
  • Met customer call guidelines for service levels, handle time and productivity.
  • Trained new personnel regarding company operations, policies and services.
  • Promoted superior experience by addressing customer concerns, demonstrating empathy, and resolving problems swiftly.
  • Delivered exceptional customer service to every customer by leveraging extensive knowledge of products and services and creating welcoming, positive experiences.
  • Cross-trained and provided backup support for organizational leadership.
  • Investigated and resolved accounting, service and delivery concerns.
  • Followed up with customers about resolved issues to maintain high standards of customer service.
  • Enhanced productivity levels by anticipating needs and delivering outstanding support.
  • Exhibited high energy and professionalism when dealing with clients and staff.

Clean Technician

Dana's Cleaning Service
06.2015 - Current
  • Assist household members with home maintenance.
  • Suggested specialized fixtures, test equipment and procedures for failure analysis.
  • Tracked and recorded parts and labor costs related to each service call.
  • Maintained compliance with regulatory standards and safety requirements.
  • Cleaned stains from fabric or garments using spray guns and cleaning fluid.
  • Liaised with internal departments to optimize productivity and efficiency.
  • Worked with diverse types of weather and ground conditions.

Administrative Data Entry Clerk

The Wichman h
02.2019 - 10.2020
  • Laid off due to COVID-19
  • Answer incoming service calls, Dispatch HVAC/Refrigeration Technician with proper instructions & documents, Receive and input payments; cash, check, debit, credit
  • Multiple weekly deposits, balancing & enter all employee expense reports, filing, verify work & charges, order supplies.
  • Entered numerical data into databases with speed and accuracy using 10-key pad.
  • Organized, sorted, and checked input data against original documents.
  • Completed data entry tasks with accuracy and efficiency.
  • Scanned documents and saved in database to keep records of essential organizational information.
  • Sorted documents and maintained organized filing process.
  • Verified accuracy of data entered into system to produce error-free reports.
  • Communicated with supervisors and colleagues to process data quickly and resolve discrepancies.
  • Collated and organized data entry documents into filing systems for easy access.
  • Resolved discrepancies in data entry activities for accurate, complete jobs.
  • Secured and protected data from unauthorized access by complying with security protocols.

Administrative Accountant Assistant

Paul Davis Restoration
05.2017 - 02.2019
  • Managed day to day operations, directed all incoming calls to appropriate departments & individuals, performed daily administrative duties such as, filing, customer service, scheduling of all associates, payroll, accounts/receivable.
  • Evaluated and improved processes, workflows and procedures to manage accounts and resolve issues.
  • Supported internal audit, external audit or other regulatory bodies.
  • Participated on special projects requiring accounting expertise, conducted ad-hoc analyses and provided solution options.
  • Participated in updates to existing platforms, integration of newly purchased applications and special projects.
  • Performed daily and monthly reconciliation of complex balance sheet accounts for cash suspense and other financial statement line item accounts.
  • Performed journal entries, month-end closing procedures and balance sheet reconciliations.
  • Managed month-end prepaid expenses, accrued expenses and other tasks to close books.
  • Assisted with preparation of external audits for companies' internal use and federal or other agency requirements.
  • Took swift action on accounting issues and system discrepancies.

Customer Service Representative 1-3

PETRO OIL
09.2015 - 02.2019
  • Greet customers and build rapport while efficiently completing transactions.
  • Accept and accurately process cash transactions on cash drawer while maintaining proper balancing procedures.
  • Check authorizing and cashing following corporate procedures.
  • Collect outstanding monetary transactions with company partners
  • Serve as resource for incoming phone calls to either directing them to correct individual or satisfying their request.
  • Responded to customer requests for products, services, and company information.
  • Offered advice and assistance to customers, paying attention to special needs or wants.
  • Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
  • Updated account information to maintain customer records.
  • Answered customer telephone calls promptly to avoid on-hold wait times.
  • Provided primary customer support to internal and external customers.
  • Processed customer service orders promptly to increase customer satisfaction.
  • Answered constant flow of customer calls with minimal wait times.
  • Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.

Medical Administrative Assistant

Bedford Urgent Care
09.2014 - 05.2015
  • Initiate and update customer records.
  • Collect data for analysis of sales sheets, phone numbers, prospects and customers.
  • Print and process invoices, statements
  • Maintain and update all office supplies.
  • Ensure filing is consistently current and accurate.
  • Word processing duties include general correspondence with internal personal, other location notes for current patients.
  • Return all phone calls and voice messages daily.
  • Supported office staff and operational requirements with administrative tasks.
  • Called patients to confirm scheduled appointments day in advance.
  • Documented patient medical information, case histories, and insurance details to facilitate smooth appointments and payment processing.
  • Organized paperwork such as charts and reports for office and patient needs.
  • Scheduled patient appointments and placed reminder calls to deliver exceptional customer experience.
  • Verified insurance coverage to prepare for upcoming patient appointments.
  • Managed master calendar and scheduled appointments for providers based on optimal patient loads and clinician availability.
  • Answered incoming calls, routed messages and resolved patient inquiries within target timeframes.
  • Provided educational documents and pamphlets to patients.
  • Maintained and updated patient records for accurate, current medical histories.
  • Generated reports and logged patient information for reliable records.
  • Collaborated with healthcare professionals to maintain high-quality care across departments.
  • Followed up with insurance companies to secure timely payment.
  • Adhered to strict HIPAA guidelines to protect patient privacy.
  • Restocked each medical room with adequate supply of medications and supplies in preparation for patients.
  • Coordinated patient scheduling, check-in, check-out and payments for billing.
  • Gathered forms and copied insurance cards to collect patient information for billing and insurance filing.
  • Directed patients to exam rooms, fielded questions, and prepared for physician examinations.
  • Received, recorded and filed medical payments by check, cash, and credit card.
  • Reconciled daily payments received and prepared deposits for smooth office finances.
  • Registered patients and completed associated paperwork for accurate records.
  • Prepared patient charts by gathering and organizing medical records ahead of appointments.
  • Provided prompt, polite and professional in-person and telephone customer service.
  • Relayed care and medication advice to patients to relieve physicians during peak hours.
  • Obtained pre-authorization from insurance companies ahead of medical services.
  • Updated patient information and insurance details for accurate electronic medical records.

Education

Bachelor of Science - Psychology

Purdue Global University
Fort Wayne, IN
09.2022

Associate - Medical Assistant/Phlebotomy

Professional Skills Institute
Maumee, OH
09.2010

Skills

  • Medical Scheduling
  • HIPAA
  • Excel
  • Organizational Skills
  • Customer Service
  • Data Collection
  • Insurance Verification
  • Accounts Receivable
  • Medical terminology
  • Medical Records
  • Quality Assurance
  • De-Escalation Techniques
  • Call Documentation
  • Calm Under Pressure

Certification

Ohio Driver license, 01/01/90, Present

Additional Information

  • RELEVANT SKILLS
  • Medical: Blood drawing, Insurance Verification, Billing, Collection, Medical Terminology, Resource Identification, Referral Network For Greater Toledo Area
  • Clerical: Scheduling, Supply Ordering and Management, Staff Training, General Computer Skills, Excel
  • Cash Handling: Balancing Shift Paperwork, Daily Deposit, Drawer Management, Efficient Cash Counting and Forecasting
  • Google Docs, Excel, Microsoft Word.October 2010-September 2016

Assessments

  • Customer service, Proficient, 07/01/20, Identifying and resolving common customer issues
  • Customer focus & orientation, Proficient, 06/01/21, Responding to customer situations with sensitivity
  • Call center customer service, Proficient, 06/01/21, Demonstrating customer service skills in a call center setting
  • Work motivation, Proficient, 05/01/20, Level of motivation and discipline applied toward work

Personal Information

Willing To Relocate: Anywhere

Work Authorization

Authorized to work in the US for any employer

Awards

Deans List, 12/01/20, Made Deans list for my G.P.A. of 3.97

Reading, painting, bullet journaling

Fell in love with books at a very young age. I am happiest with a great story of historical value and learning something new. Constantly working with my plants inside and out during the times of year can extend outdoors.

Timeline

Member Services Representative

CVS/AETNA
10.2021 - Current

Administrative Data Entry Clerk

The Wichman h
02.2019 - 10.2020

Administrative Accountant Assistant

Paul Davis Restoration
05.2017 - 02.2019

Customer Service Representative 1-3

PETRO OIL
09.2015 - 02.2019

Clean Technician

Dana's Cleaning Service
06.2015 - Current

Medical Administrative Assistant

Bedford Urgent Care
09.2014 - 05.2015

Bachelor of Science - Psychology

Purdue Global University

Associate - Medical Assistant/Phlebotomy

Professional Skills Institute

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Rachel JamesMember Advocate