Rita Scholz
Appleton,WI
Summary
Customer service professional with strong background in managing customer interactions and resolving issues promptly. Committed to enhancing team collaboration and achieving consistent results. Recognized for adaptability in dynamic environments and proficiency in handling customer concerns and inquiries While Using Salesforce (CRM platform) and Smartsheets to increase proficiency , boost my productivity ,create personalized customer content, and answer customer questions
Overview
9
9
years of professional experience
Work History
Medical Work Comp Bill Review Specialist/Senior Customer Service Representative
Charles Taylor
07.2022 - 01.2025
- Company Overview: Optum
- Utilized Strata Ware, Citrix, Excel, Teams, WeQ , CMR, Salesforce and various software systems to validate and match data in claims image
- Edited, entered, and updated bill information efficiently
- Directed claims to appropriate department as necessary
- Maintained up-to-date knowledge of CPT/ICD codes through ongoing education
- Imported bills into Strata Ware and conducted test bills for new clients
- Enrolled in Texas Workers Compensation Adjuster courses to obtain license
- Optum
- Managed a high volume of reviews within tight deadlines, ensuring timely completion and client satisfaction.
Account Manager Claims
Humana
07.2021 - 07.2022
- Company Overview: Optum
- Addressed customer needs, including complex benefit questions, issue resolution, and member education
- Using Salesforce (CRM platform) and Smartsheets to increase proficiency , boost my productivity ,create personalized customer content, and answer customer questions
- Recorded details of inquiries, comments, complaints, transactions, and interactions, and took appropriate action
- Escalated unresolved and pending customer grievances
- Made decisions regarding daily priorities for an administrative work group and/or external vendors, coordinating work activities and monitoring progress towards schedules/goals
- Oversaw work of others and/or served as primary administrative owner of a main process, program, product, or technology
- Worked within broad guidelines with little oversight
- Provided coaching, resources, and development opportunities
- Served as point of contact for new hires and current employees regarding compliance processes
- Updated compliance records for new and current employees, as well as changes to personal information
- Identified problems or concerns in employee hiring processes
- Proposed changes in procedures and identified areas for improvement
- Required 2 years of HR, onboarding, or Credentialing administration experience in a high-volume environment
- Required 2 years of responsible administrative experience
- Ability to type at least 50 net words per minute
- Proficiency in word processing, spreadsheets, and database systems
- Thrived in a fast-paced environment and managed multiple priorities and projects effectively
- Utilized office equipment and demonstrated strong multitasking abilities
- Optum
Authorization Matching/ Provider Services
WPS Health Solutions
01.2020 - 07.2021
- Company Overview: Optum
- Analyze claims to be determine if all claims filing requirements have been met
- Update line items to complete adjudication of claims
- Analyze claims to determine if eligibility requirements and claim filing requirements are met and make determinations
- Maintain integrity of claim auditing system by identifying and reporting potential system problems
- Provide examples and documentation to support findings
- Deal tactfully with people in a wide variety of situations to convey a favorable corporate image
- Initiate written communication via web application letter writing system
- Keep with in daily/weekly/ monthly Stats
- Maintain a positive and professional attitude
- Work with members of staff on identifying process improvements
- Perform other duties as assigned by management
- Using Salesforce (CRM platform) and Smartsheets to increase proficiency , boost my productivity ,create personalized customer content, and answer customer questions
- Streamlined communication between providers and insurance companies for faster claim processing and improved relationships.
- Enhanced customer satisfaction by promptly addressing inquiries and resolving issues related to provider services.
- Demonstrated adaptability when navigating multiple software platforms daily to manage tasks efficiently while maintaining accurate records for all involved parties.
At Home Customer Service Representative
Adecco
10.2019 - 01.2020
- Company Overview: PetSmart
- Assist with placing orders, store complaints
- Provided exceptional customer service to clients via phone, email, and live chat, resolving issues in a timely and professional manner
- Processed orders, returns, and exchanges accurately and efficiently, ensuring customer satisfaction and loyalty
- Acted as a liaison between customers and various departments within the company, effectively communicating and coordinating solutions to meet customer needs
- Managed a high volume of incoming calls and messages, consistently meeting performance metrics for response times and customer satisfaction ratings
- PetSmart
Customer service representative
Brook source staffing
09.2019 - 10.2019
- Provided exceptional customer service by assisting members with opening membership accounts
- Resolved debit/ credit card credit and disputes efficiently and effectively
- Facilitated wire transfers for members accurately and promptly
- Processed internal and external transfers with precision
- Provided technical support for online banking and addressed balance inquiries promptly
Provider Relations Representative
CYPRESS BENEFIT ADMINISTRATORS
02.2019 - 09.2019
- Provide responsive and professional customer service to providers regarding status of medical and dental claims
- Utilize necessary resources and navigate systems efficiently to accurately verify eligibility and provide verification of benefits
- Assist providers in getting set up and utilizing Provider Portal
- Maintain a positive and professional attitude
- Work with members of staff on identifying process improvements
- Perform other duties as assigned by management
- Using Salesforce (CRM platform) and Smartsheets to increase proficiency , boost my productivity ,create personalized customer content, and answer customer questions
Tier 2 Technical Chat / phone Support agent
Kelly Services
05.2016 - 02.2019
- Assist customers with technical issues with their devices
- Assist with Apple ID, iCloud and iTunes Store issues
- Met monthly goals and expectations
- Office Manager within 3 months of hire
- Permanent floorwalker to assist other advisors for both OS and iOS chats
- Performed initial client assessment and analysis to begin research process
- Researched and updated all required materials needed for firm and partners
- Provided base level IT support to non-technical personnel within the business
- Evaluated and responded to incoming sales leads and requests for technical support assistance
- Reviewed technical documentation and procedures
- Installed software, modified, and repaired hardware and resolved technical issues
- Remained up-to-date on the latest technologies and solutions applicable to company products
- Identified and solved technical issues with a variety of diagnostic tools
- Defined and documented technical best practices
- Managed call flow and responded to technical support needs of customers
- Resolved problems with malfunctioning products
- Assisted customers with order placing
- Retained existing clients and developed new business by extending high quality and efficient service
- Appropriately documented all transactions and pertinent interactions
- Managed customers' expectations and experience to a high degree of customer satisfaction
- Maintained and updated customer service database
- Used ticketing systems to manage and process actions taken
- Provided on-call support for critical issues
- Always demonstrated professionalism and courtesy with customers
- Conducted research to address customer concerns
- Worked closely with team members to meet or exceed all customer service requirements
- Engaged users and answered questions on website and in forums
- Using Salesforce (CRM platform) to increase proficiency , boost my productivity ,create personalized customer content, and answer customer questions
Education
High School Diploma -
BROWN DEER HIGH SCHOOL
Brown Deer, WI06-1991
Skills
- Customer support
- Complaint resolution
- Quality assurance
- Payment processing
- Call control
- Database management
- Account management
- Conflict management
- Call center experience
- Procedure writing
- Live chat support
- CRM software
- Email management
- Call auditing
- Customer service
- Using Salesforce (CRM platform) and Smartsheets to increase proficiency , boost my productivity ,create personalized customer content, and answer customer questions
- Problem-solving
- Time management
- Attention to detail
- Dependable and responsible
Timeline
Medical Work Comp Bill Review Specialist/Senior Customer Service Representative
Charles Taylor
07.2022 - 01.2025
Account Manager Claims
Humana
07.2021 - 07.2022
Authorization Matching/ Provider Services
WPS Health Solutions
01.2020 - 07.2021
At Home Customer Service Representative
Adecco
10.2019 - 01.2020
Customer service representative
Brook source staffing
09.2019 - 10.2019
Provider Relations Representative
CYPRESS BENEFIT ADMINISTRATORS
02.2019 - 09.2019
Tier 2 Technical Chat / phone Support agent
Kelly Services
05.2016 - 02.2019
High School Diploma -
BROWN DEER HIGH SCHOOL
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