Sarah Wheeler

Blue Cross Blue Shield of Massachusets

Medex Floor Support Supervisor

• Provided live coaching to representatives to ensure accuracy and first-call resolution.
• Handled escalated calls and resolved members’ requests to guarantee member satisfaction.
• Trained new staff on company policies, enhancing team performance and service delivery.
• Promoted a positive work environment through open communication channels, fostering team collaboration and high morale.
• Coached employees through day-to-day work and complex problems.
• Ensured friendly service by employing de-escalation techniques and conflict resolution strategies.
• Analyzed claims to ensure accuracy of information between insurance and provider to allow members’ benefits to be carried out.
• Supported members in navigating billing statements and benefits in collaboration with Medicare
• Cultivated expert-level knowledge of various policies’ plan benefits and articulated complex insurance information to members.
• Communicated with multiple departments through written correspondence to acquire relevant information and coordinate solutions for members.
• Utilized established scripts and workflows for effective problem resolution.
• Documented member calls to clearly articulate original issues and final resolutions.
• Ensured HIPAA adherence via thorough member verification and proper documentation of authorized representatives.
• Applied expertise in Medicare processes and policies to provide detailed explanations to members and other representatives.
• Collaborated with cross-functional teams to streamline workflow processes and enhance operational efficiency.
• Managed escalated calls effectively, utilizing problem-solving skills to resolve complex issues, ensuring first call resolution (FCR)
• Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.

Wellsense Health Plan

Member & Provider Services Representative

• Managed high-volume inbound calls, providing efficient support to members and providers.
• Exhibited extensive knowledge of medical claims and insurance terminology.
• Rapidly acquired proficiency in new software applications and systems.
• Documented accurate and detailed notes demonstrating exceptional attention to detail.
• Collaborated with internal departments and MassHealth to streamline processes.
• Secured first-call resolution while limiting member participation.
• Applied expertise in Medicaid and MassHealth processes to support seamless coordination with WellSense Health Plan.
• Coordinated with internal departments on behalf of providers to ensure timely payment resolution for claims disputes or other financial matters.
• Served as liaison between providers and company leadership, effectively conveying concerns and feedback to drive continuous improvement initiatives.
• Increased efficiency by accurately entering provider data into company systems and databases.
• Educated providers on billing procedures, coding guidelines, and reimbursement policies for optimal claim submissions.

Democracy Federal Credit

Phone Bank Teller Member Services

• Resolved customer inquiries through phone and email, ensuring prompt and accurate responses.
• Assisted members in navigating online banking platforms, enhancing user experience and satisfaction.
• Processed loan applications and financial transactions, maintaining compliance with credit union policies.
• Collaborated with team members to streamline processes, improving overall service efficiency.
• Educated customers on credit union products and services, driving informed decision-making.
• Handled escalated issues effectively, demonstrating problem-solving skills in high-pressure situations.

• Provided live coaching to representatives to ensure accuracy and first-call resolution.
• Handled escalated calls and resolved members’ requests to guarantee member satisfaction.
• Trained new staff on company policies, enhancing team performance and service delivery.
• Promoted a positive work environment through open communication channels, fostering team collaboration and high morale.
• Coached employees through day-to-day work and complex problems.
• Ensured friendly service by employing de-escalation techniques and conflict resolution strategies.
• Analyzed claims to ensure accuracy of information between insurance and provider to allow members’ benefits to be carried out.
• Supported members in navigating billing statements and benefits in collaboration with Medicare
• Cultivated expert-level knowledge of various policies’ plan benefits and articulated complex insurance information to members.
• Communicated with multiple departments through written correspondence to acquire relevant information and coordinate solutions for members.
• Utilized established scripts and workflows for effective problem resolution.
• Documented member calls to clearly articulate original issues and final resolutions.
• Ensured HIPAA adherence via thorough member verification and proper documentation of authorized representatives.
• Applied expertise in Medicare processes and policies to provide detailed explanations to members and other representatives.
• Collaborated with cross-functional teams to streamline workflow processes and enhance operational efficiency.
• Managed escalated calls effectively, utilizing problem-solving skills to resolve complex issues, ensuring first call resolution (FCR)
• Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.

• Managed high-volume inbound calls, providing efficient support to members and providers.
• Exhibited extensive knowledge of medical claims and insurance terminology.
• Rapidly acquired proficiency in new software applications and systems.
• Documented accurate and detailed notes demonstrating exceptional attention to detail.
• Collaborated with internal departments and MassHealth to streamline processes.
• Secured first-call resolution while limiting member participation.
• Applied expertise in Medicaid and MassHealth processes to support seamless coordination with WellSense Health Plan.
• Coordinated with internal departments on behalf of providers to ensure timely payment resolution for claims disputes or other financial matters.
• Served as liaison between providers and company leadership, effectively conveying concerns and feedback to drive continuous improvement initiatives.
• Increased efficiency by accurately entering provider data into company systems and databases.
• Educated providers on billing procedures, coding guidelines, and reimbursement policies for optimal claim submissions.