Summary
Overview
Work History
Education
Skills
Timeline
Generic

Renisha Faison

Layton,FL

Summary

Qualified professional, passionate about promoting lasting customer satisfaction by delivering topnotch service and unparalleled support. Service-focused individual bringing 5+ years of experience in customer relations, task prioritization, time management and claims processing. Committed to facilitate positive experiences through high- quality client care and prompt resolution of complaints and issues. Motivated to maintain customer satisfaction and contribute to company success. Authorized to work in the US for any employer

Overview

10
10
years of professional experience

Work History

Claims Representative

Imagenet (Optum)
Tampa, FL
03.2024 - Current
  • Handle all inquiries from medical provider or third party team regarding the status of a claim.
  • Research and develop appeals for denied claims
  • Identify viable payer(s) and obtain all necessary documentation to properly process the claim for payment including , when applicable, IBs,Ubs Medical records ,EOBS ,W9 and etc
  • Ensured timely submission of required documentation from claimants prior to approval of payment.
  • Adhered to strict guidelines pertaining to confidentiality while handling sensitive personal information.
  • Reviewed and verified claim information to ensure accuracy of data and compliance with established policies.
  • Maintained detailed records of all communication with customers, claimants, providers, and internal departments.
  • Documented changes in claim statuses using specialized software systems.

Customer Service Representative

Florida Department of Children and Families
Tampa
10.2021 - 12.2022
  • Maintained accurate records on in-progress and completed referrals, ensuring full data integrity throughout process
  • Collected and verified completeness of intake and enrollment screening packets for DCF
  • Linked families to relevant community support to meet non-medical needs
  • Followed up with clients and specialists to inquire about family needs such as snap benefits
  • Scheduled appointments with specialists on behalf of the state of FL.

Benefits Specialist

Aetna
Tampa
11.2019 - 10.2021
  • Offered internal and external customers first-rate customer service to maximize satisfaction and business success
  • Calculated adjustments, premiums, and refunds
  • Reported policy changes and company conditions affecting customer satisfaction
  • Interviewed policyholders to verify information and obtain additional details
  • Addressed customer complaints and mitigated dissatisfaction by employing timely and on-point
  • Explained benefits to plan participants in easy to understand terms in order to educate each on available options
  • Located providers for employee medical, dental and life
  • Managed continuous enrollment processes, as well as yearly enrollment periods.

Customer Service Representative

Healthplan Services/Cigna
Tampa
12.2017 - 11.2019
  • Promoted superior experience by addressing customer concerns, demonstrating empathy and resolving problems swiftly
  • Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable
  • Identified and resolved patient billing and payment issues
  • Communicated effectively and extensively with other departments to resolve claims issues
  • Precisely evaluated and verified benefits and eligibility
  • Communicated with patients for unpaid claims for HMO, PPO and private accounts and delivered friendly follow-up calls for proper payments to contracts
  • Collected payments and applied to patient accounts.

Claims Representative

Convergy
Tampa
06.2016 - 08.2017
  • Examined reports, accounts and evidence to determine integrity and accuracy of information
  • Proposed settlements for uncomplicated issues to resolve claims
  • Followed up with customers on unresolved issues
  • Worked productively in fast-moving work environment to process large volumes of claims
  • Coordinated with contracting department to resolve payer issues.

Order Support Specialist

Computer Generated Solutions, Inc. /Sprint
Tampa
08.2014 - 03.2016
  • Adhered to company policies and scripts to consistently achieve call-time and quality standards
  • Resolved concerns with products or services to help with retention and drive sales
  • Leveraged sales expertise to promote products and capitalize on upsell opportunities
  • Achieved high satisfaction rating through proactive one-call resolutions of customer issues
  • Responded to customer calls and emails to answer questions about products and services
  • Collaborated with shipping team to track shipments, verify orders and handle product returns
  • Approved and terminated customer contracts upon request
  • Assisted customers by answering questions and responding to inquiries
  • Processed debit and credit card and electronic check payments
  • Educated customers on company systems, form completion and access to services
  • Engaged in learning and development opportunities to promote continued performance improvement
  • Placed outbound customer service or customer satisfaction calls to follow up on issues.

Education

Diploma -

Hillsborough High School Tampa
01.2011

Skills

  • Customer service excellence
  • Documentation proficient
  • Efficient and Detail-Oriented
  • Data entry
  • Upselling
  • Communication skills
  • Policy understanding
  • Time Management
  • Documentation research
  • Decision-Making
  • Team Collaboration
  • Microsoft Office

Timeline

Claims Representative

Imagenet (Optum)
03.2024 - Current

Customer Service Representative

Florida Department of Children and Families
10.2021 - 12.2022

Benefits Specialist

Aetna
11.2019 - 10.2021

Customer Service Representative

Healthplan Services/Cigna
12.2017 - 11.2019

Claims Representative

Convergy
06.2016 - 08.2017

Order Support Specialist

Computer Generated Solutions, Inc. /Sprint
08.2014 - 03.2016

Diploma -

Hillsborough High School Tampa

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Renisha Faison