Sabrina Arrington
Delta Dental of Michigan
Redford
14
years of professional experience
Highly motivated professional experienced in handling customer interactions and resolving issues promptly. Utilizes communication and empathy to build strong customer relationships. Track record of maintaining high customer satisfaction, meeting organizational goals and fostering loyalty.
Work History
Government Programs Customer Service Representative
2 Years 1 Month- Promptly and professionally responds to member, client and provider questions through multiple channels, including, but not limited to telephone, email, fax and U.S. mail communication using proper etiquette, grammar, punctuation, etc.
- Clearly and accurately communicates all eligibility, benefit, claim status and payment information related to caller’s questions
- Properly identifies the reason(s) for the call and provides appropriate resolution to inquiries and complaints within specified timeframes and guidelines established by regulatory agencies or client contracts.
- Inform and assist callers with grievance and claims appeals processes.
- Clearly, accurately and thoroughly documents information in the customer relationship management system to ensure all relevant details of the phone call are captured.
- Understands the importance of adhering to regulatory requirements
- Meets or exceeds quality standards as required for position
- Meets or exceeds call center metrics as required for position
- Enters and adjusts claims as required
- Streamline workflow processes to enhance team efficiency and reduce response times.
- Manage high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Resolve customer complaints with empathy, resulting in increased loyalty and repeat business.
- Serves as peer mentor and call evaluator/service observer for CSRs newly trained to Medicare Advantage (MA). Provide live assistance to CSRs while they take calls in the training environment. Evaluate new MA CSRs' ability to take calls independently at the end of training.
Grievances and Appeals Coordinator
2 Years 3 Months- Processed customer appeals and grievances to ensure compliance with regulations.
- Analyze, research, resolve and provide comprehensive responses to high level inquiries, referrals, complaints, and appeals received from various regulatory agencies and other sources and provide comprehensive responses in accordance with established regulatory and accreditation guidelines.
- Analyzed and resolved high-level inquiries, referrals, complaints, and appeals from regulatory agencies, delivering comprehensive responses aligned with regulatory and accreditation guidelines.
- Contacted customers to gather information and communicated case disposition, ensuring clarity and understanding.
- Conducted research to evaluate and finalize cases, enhancing response accuracy and effectiveness.
- Daily interface included members, providers, other BCBSM departments, Medicare and national BCBS plans
- Maintained familiarity with standard concepts and practices in data analysis. concepts, practices, and procedures for analyzing, interpreting data and applying contract and regulatory provisions
Disability Representative
9 Months- Processed Short Disability and Leave of Absence claims efficiently to ensure timely support for employees
- Guided employees through claims process, addressing questions and concerns to enhance understanding and satisfaction
- Communicate with physicians, HR representatives and other members to obtain clinical documentation that may support claim
- Coordinated communication with physicians, HR representatives, and stakeholders to gather necessary clinical documentation for claims
- Accurately process claim payments if applicable
- Remain in compliance with FMLA, LEAVE, ERISA AND HIPAA regulations
Medical Information Specialist
3 Years 7 Months- Managed high-volume call center operations in fast paced environment that handles 230k calls annually
- Monitored telephone service factors, including abandonment rates, average speed to answer, and average call handling, to optimize service delivery.
- Intake and management of organization determinations for multiple product lines for HMO and Medicare members
- Applied CPT coding knowledge for medical services, HCPCS and ICD-10 codes for medical services
- Facilitated clinical questionnaire administration for case review for services and pend cases appropriately that require clinical review
- Experience with managing NCQA and CMS turnaround times for case processing and audit readiness
- Identified and resolved provider issues regarding authorizations to maintain compliance and enhance service quality.
Customer Service Representative III
3 Years 9 Months- Provide customer support in fast-paced call center for Ford, GM & FCA/Chrysler employees and UAW retirees
- Educated members on health care coverage, enhancing understanding of benefits
- Requested resubmission of member medical claims with pricing department, ensuring accurate processing aligned with health benefits
- Interfaced daily with BCBSM departments, national BCBS plans, providers, and UAW customer service center, facilitating seamless communication
Education
Bachelors Degree - Business Administration
Skills
Claims Processing
HCPCS/CPT/CDT Coding
Healthcare Regulations
CMS guidelines
Call center operations
Customer Service
Critical Thinking
De-escalation techniques
Conflict resolution strategies
Active listening
AWARDS
DEANS LIST, BCBSM 5 YEARS OF SERVICE AWARD, CUSTOMER EXCELLENCE AWARD
Timeline
Government Programs Customer Service Representative
Delta Dental of Michigan
07.2024 - CurrentRead More
Grievances and Appeals Coordinator
Blue Cross Blue Shield of Michigan
08.2020 - 11.2022Read More
Disability Representative
Sedgwick
11.2019 - 08.2020Read More
Medical Information Specialist
Blue Cross Blue Shield of Michigan/Blue Care Network
04.2016 - 11.2019Read More
Customer Service Representative III
Blue Cross Blue Shield of Michigan
07.2012 - 04.2016Read More
Davenport University
Bachelors Degree from Business Administration
Read More