RONALD MAHLASERA
Frisco
Summary
Seeking a mutually beneficial position, that utilizes my experience in Customer care whilst offering me the potential for growth and career development.
Team player with the ability to successfully manage multiple priorities and assignments Possess effective presentation, verbal and written communication skills Strong drive to make things happen and to see events through to successful conclusion Ability to identify needs, opportunities and priorities timely and act before a crisis
Overview
16
16
years of professional experience
Work History
Customer Care Specialist
Careington International Corporation
09.2024 - Current
- Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
- Verified accuracy of customer account information and updated when necessary.
- Provided exceptional support during high call volume periods, maintaining a professional demeanor under pressure.
- Reduced customer complaints by efficiently resolving issues through effective communication and problem-solving skills.
- Responded to customer needs through competent customer service and prompt problem-solving.
Benefit Verification Specialist
LASH GROUP
11.2014 - 12.2018
- Effective time management, organizational skills ,data entry, benefit verifications (initial, subsequent, and re-verifications), ensuring maximum reimbursement and follow-up for the provider, obtaining accurate benefits in order to qualify patients for copay or patient assistance programs offered by the manufacturer, prior authorization and pre-determination initiation processes, reviewing medical policies (verbally or online) to ensure procedure acceptance ,assisting Site Coordinators with accurate benefit information ,Multi-Tasking, Voluntary Self-Improvement and Education opportunities in order to enhance my knowledge and familiarity with Medicare, Medicaid, Tricare and various private payer medical policies and guidelines, CPT and ICD-9 code additions
- Achieved the highest quality overall on my team during the first week after going live
- Reached and went above my daily goals every day at least 18 records a day
Member Service Agent
PRIME THERAPEUTICS
01.2010 - 01.2014
- Cultivate customer trust by providing members and pharmacies with accurate information regarding benefit plans to assure member and client satisfaction and accurate claims processing
- Receive incoming calls from customers in accordance with department standards and other verbal and written training memorandums
- Make outbound calls as needed regarding member benefits
- Maintain professional and courteous communication resulting in high call quality
- Investigate and resolve phone inquiries in a timely manner
- Forward escalated calls as needed to Senior Service Agents or Supervisors
- Follow proper procedures for accurate and timely documentation of customer concerns and other related issues
- Meet and/or exceed departmental employee performance standards
- Maintain Guiding Principal and demand the highest standards of conduct from self and others
- Other duties as assigned
Verification and Quality Assurance
HMS
01.2009 - 01.2010
- Assist the corporate Quality Assurance department with Quality Assurance work as directed
- Investigate and resolve data inconsistencies
- Suggest areas for process and procedural improvement and report to Supervisor
- Perform internal department production audits
- Audit Verification Representatives work for accuracy
- Audit verified insurance policies for accuracy
- Apply judgment in sampling versus full-populations quality assurance methods
- Approve batch or send back for re-work
- Provide back up support for all functions of team
Education
No Degree - Nursing
Dallas Nursing Institute
Dallas, TXSkills
- Data Entry
- Microsoft Word
- Internet
- Database Packages
- Microsoft Excel
- AS400
- Payment processing
- Quality assurance
- Customer service excellence
- Inbound customer service
- Call center experience
- Customer service
Timeline
Customer Care Specialist
Careington International Corporation
09.2024 - Current
Benefit Verification Specialist
LASH GROUP
11.2014 - 12.2018
Member Service Agent
PRIME THERAPEUTICS
01.2010 - 01.2014
Verification and Quality Assurance
HMS
01.2009 - 01.2010
No Degree - Nursing
Dallas Nursing Institute
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