Rodaija Parks
Tampa,Florida
Summary
I am a hardworking and responsible individual with expanding on my experiences. I am a team player with excellent communication abilities and strong customer support capabilities. I have experience in health insurance claims processing, Prior authorization review and coordinating cases. and expertise in life and health insurance claim management. Proficient in analyzing claims, ensuring compliance with regulations, and collaborating with healthcare providers to resolve discrepancies. Seeking to leverage my skills in a dynamic role to enhance claims efficiency and improve customer satisfaction. Communicative customer service professional motivated to maintain customer satisfaction and contribute to company success. History managing large amounts of inbound calls and sustaining satisfactory relationships with customers. Offers skill with CRM systems paired with outstanding active listening and multitasking abilities.
Overview
8
8
years of professional experience
Work History
Customer Service Representative
Health Plan One
Tampa, USA
03.2021 - 02.2025
- Provides exceptional customer service by responding to all inbound customer calls and written correspondences
- Respond to written and telephone inquiries from providers and clients
- Actively listens to customers' requests and inquiries
- Enters information into our internal system to record, track, and monitor inquiries
- Acts as the caller's advocate to ensure their questions and concerns are addressed in a timely and professional manner
- Have excellent oral & written communication skills along with engaging phone voice and telephone etiquette
- Works in a fast-paced team environment, and is ready to learn new things.
- Maintained detailed records of customer interactions, transactions and comments for future reference.
- Conducted regular follow-up calls with customers after resolving their issues.
Claims/customer Service
Health Plan Services
03.2017 - 02.2021
- Process identification and data entry of referral requests into the UM systems
- Maintain positive customer relations and coordinate with functions within the company
- Responds to telephone and from providers, clients
- Determine benefit eligibility, inpatients and outpatient precertification, prior authorization
- Check Benefits
- Check Eligibility provides authorization for inpatient, outpatient precertification, prior authorization, and post service requests
- Process enrollment and eligibility changes from members and/or internal report
- Validating the accuracy of claimant benefit amount and ensuring all payments were executed in compliance with authorized guidelines
- Provided customer service to policyholders and claimants by answering phone calls, responding to emails, and addressing inquiries.
- Advised customers on proper procedures for filing a claim or resolving an issue with their policy.
- Conducted follow-up calls with customers to ensure satisfaction with services provided.
Skills
- Self-direct
- Microsoft Word
- Excel
- PowerPoint
- Access
- Insurance Verification
- Data Entry and Database Management
- Inbound and outbound calling
- Positive and professional
- Critical thinking
- Call center experience
Timeline
Customer Service Representative
Health Plan One
03.2021 - 02.2025
Claims/customer Service
Health Plan Services
03.2017 - 02.2021