Ndia Johnson
Charlotte,United States
Summary
Supportive Eligibility Specialist with extensive application engagement and dedicated service skills. Bilingual professional with skill to maintain accurate records, schedule appointments and handle various administrative responsibilities.
Overview
5
5
years of professional experience
Work History
Eligibility Specialist
Department Of Social Services
Charlotte , NC
01.2022 - Current
- Identified job seekers with job searching challenges to strategize success plans.
- Sorted out jobs relevant to interests of candidates to forward information to candidates.
- Reviewed applications for different aid programs and determined which qualification criteria for individuals.
- Developed extensive fact-checking and research skills as result of continuously reviewing different programs and options.
- Communicated with people from various cultures and backgrounds on application process.
- Scheduled appointments with applicants to gather information and explain benefits processes.
- Followed guidelines when reviewing applicant data to determine eligibility for economic assistance.
- Interviewed applicants and explained scope of different available benefits.
- Assessed information gleaned from interviews, educational, and medical records, consultation with other professionals and diagnostic evaluations to identify clients' abilities, needs and eligibility for services.
- Managed processing of financial assistance and food stamp benefits applications.
- Educated patients on eligibility and affordability options by offering insightful information.
- Kept up-to-date with labor market information and professional developments by visiting training providers, professional bodies and employers.
- Used computer-aided guidance packages such as skills assessment tools, career planners, psychometric tests and personal inventories to assist clients in determining strengths and weaknesses.
- Selected qualified applicants to refer to employers for possible job placement purposes.
- Wrote job orders from employers to record accurate description of required job duties, working hours and wages.
Inbound Customer Service Representative 2
Humana
04.2020 - 05.2022
- Sought out training opportunities to enhance customer relationship management abilities and further boost satisfaction scores.
- Referred complex issues relating to online order system or technology to help desk for further evaluation.
- Answered phone with friendly greeting to create positive inbound calling experience for customers.
- Resolved complaints to satisfy customers and encourage future transactions.
- Built long-term, loyal customer relations by providing top-notch service and detailed order, account and service information.
- Asked fact-finding questions to determine customer needs and expectations and recommended specific products and solutions.
- Educated customers about product terminology, features and benefits to improve sales and customer satisfaction.
- Fielded customer questions regarding available merchandise, sales, current prices and upcoming company changes.
- Maintained organized and secure customer files to facilitate customer support and follow-up.
- Offered technical support for online purchases and helped customer navigate website to facilitate buying process.
- Processed customer order, quote and return transactions and offered additional products and services.
- Used consultative sales approach to understand customer needs and recommend relevant offerings.
- Promoted available products and services to customers during service, account management and order calls.
- Generated new and repeat sales by offering timely product, service and technical information.
- Incorporated cross-selling, up-selling and add-ons and offered promotional items to increase sales.
- Furnished accurate product information and shipping instructions and offered alternatives for out-of-stock items to support customer buying decisions.
- Resolved concerns with products or services to help with retention and drive sales.
- Responded to customer comments and questions via LiveChat during shifts.
- Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
- Adhered to company policies and scripts to consistently achieve call-time and quality standards.
- Documented and detailed calls and complaints using call center's CRM database.
- Answered over Number calls per shift to meet fast-paced call center demands.
- Achieved high satisfaction rating through proactive one-call resolutions of customer issues.
- Educated customers on current promotions, upgrades or new offerings available under current plan.
- Addressed escalated customer service issues sent from sales and service teams to save customer relationships.
- Researched issues through identification of similar past problems and recommended most appropriate solution.
- Detailed payment options and transferred customers to billing department for payment or further questions regarding bill.
- Maintained accurate and current customer account data with manual forms processing and digital information updates.
- Described product highlights and benefits to help guide purchasing decisions.
- Contributed to company achieving and holding industry-leading customer service ratings.
- Performed various clerical duties by filing and faxing documents and creating customer databases.
- Initiated termination of customer contract upon request.
Medical Claims Specialist
Kelly Services
, Iowa
02.2019 - 04.2020
- Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.
- Managed large volume of medical claims on daily basis.
- Paid or denied medical claims based upon established claims processing criteria.
- Responded to correspondence from insurance companies.
- Used administrative guidelines as resource or to answer questions when processing medical claims.
- Reviewed provider coding information to report services and verify correctness.
- Evaluated accuracy and quality of data entered into agency management system.
- Collaborated with claims department and industry anti-fraud organizations to resolve claims.
- Followed up on potentially fraudulent claims initiated by claims representatives.
- Checked documentation for accuracy and validity on updated systems.
- Carried out administrative tasks by communicating with clients, distributing mail and scanning documents.
- Verified client information by analyzing existing evidence on file.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Processed and recorded new policies and claims.
- Posted payments to accounts and maintained records.
- Prepared insurance claim forms or related documents and reviewed for completeness.
- Maintained confidentiality of patient finances, records and health statuses.
- Modified, updated and processed existing policies.
- Communicated verification and authorization status updates with Type department to facilitate decision-making for patient admissions and insurance coverage.
- Reviewed outstanding requests and redirected workloads to complete projects on time.
- Coordinated with contracting department to resolve payer issues.
- Notified insurance agents and accounting departments of policy cancellations and changes.
- Collected premiums and issued accurate receipts.
- Presented insurance options to customers in order to close sales on new policies.
- Determined appropriateness of payers to protect organization and minimize risk.
- Generated, posted and attached information to claim files.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Calculated adjustments, premiums, and refunds.
Education
Bachelor Of Applied Science - Health Administration
University of North Carolina At Charlotte
Charlotte, NC05.2021
Skills
- Application Assessments
- Program Knowledge
- Applicant Engagement
- Intakes and Assessments
- Diagnostic Evaluation
- Outbound Calls
- Resource Information
- Calendar Software
- Product Selection
- Security Administration
- Administrative Support
- Eligibility Requirements
- Telephone Etiquette
- Enrollment Procedures
- Paperwork and Documentation
- Advocacy and Counseling
- Medical Assistance
- POS Systems
- Gathering Referrals
- Admissions Screening
- Economic Reviews
- Clerical Skills
- Provider Enrollment
- Client Interviews
- HIPAA Regulations
- Constructive Feedback
- Case Records Review
- Recordkeeping
- Patient Scheduling
Timeline
Eligibility Specialist
Department Of Social Services
01.2022 - Current
Inbound Customer Service Representative 2
Humana
04.2020 - 05.2022
Medical Claims Specialist
Kelly Services
02.2019 - 04.2020
Bachelor Of Applied Science - Health Administration
University of North Carolina At Charlotte
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