Sarah Simone Shilow
San Antonio,TX
Summary
Dedicated and experienced customer service professional with 10 + years, including 4 years in healthcare. Also 1 year in debit and credit fraud department. Accustomed to working in a fast-paced environments with the ability to think and act quickly. Seeking a position that is customer focused that works directly and ensures a positive experience.
Overview
10
10
years of professional experience
4
4
years of post-secondary education
Work History
Member Debt Solutions
Apex Systems | USAA
San Antonio, TX
11.2021 - 03.2022
- Uses established procedures and significant job experience to carry out and resolve moderately complex to complex work assignments and conducts member research as necessary
- Serves as a resource to less experienced team members on escalated issues
- Offers peer support as business to team
- Contacts members in all stages of delinquency and across all USAA product lines through automated and manual outbound dialing; receives inbound collections and general servicing calls
- Under minimal supervision, performs individual member needs assessment to quickly determine the member's reason for delinquency and provide customized solutions and advice to improve their financial security
- Negotiates mutually satisfactory payment arrangements
- Actively uses and educates members on the debt analyzer and money manager tools on usaa.com
- Completes required account verification, account maintenance, and documents all contact and collection attempts
- Follows the Fair Credit Reporting Act (FCRA) and all other applicable local, state, and national laws and regulation surrounding the collection industry
- May participate and partner as a resource to support projects and/or initiatives within Member Debt
- Solutions.
- Liaised with sales, marketing and management teams to develop solutions and accomplish shared objectives.
- Developed highly empathetic client relationships and earned reputation for exceeding service standard goals.
- Promoted available products and services to customers during service, account management and order calls.
- Exhibited high energy and professionalism when dealing with clients and staff.
- Contacted clients to verify account information and maintain accuracy, resulting in 35% increase in client satisfaction.
Senior Medical Claims Examiner
WellMed
San Antonio, TX
03.2020 - 11.2021
- Remarkable experience in processing medical claims
- Evaluated original investigation reports and documents to resolve secondary concerns.
- Determined if the policy of the insured covered the loss claimed
- Reviewed complex claims as an extra set of eyes to assist the claims adjuster and checked on the case regularly to ensure proper guidelines were followed
- Detailed all conversations and filed periodic reports for review by claims managers
- Obtained physician statements and relevant medical records often limiting the company's liability
- Investigated claims to ensure they were not fraudulent.
- Handled provider demographic up-dates to claims system
- Examined, data enter, calculated and adjudicated insurance claims complying with federal, state and county laws, plan policy and company procedures
- Entered codes and verified data for computer processing
- Maintained individual production count
- Updated and maintained policy manual timely.
- Followed up with insured individuals regarding premium and deductibles payments.
- Followed up on potentially fraudulent claims initiated by claims representatives.
- Managed large volume of medical claims on daily basis.
- Synthesized data into comprehensive quarterly written reports for management.
- Maintained suspicious claims database and prepared reports for supervisors.
- Directed and coordinated various investigations conducted by field investigation team.
- Reviewed questionable claims by conducting agent and claimant interviews to correct omissions and errors.
- Used administrative guidelines as resource or to answer questions when processing medical claims.
- Responded to correspondence from insurance companies.
- Paid or denied medical claims based upon established claims processing criteria.
- Reported policy changes and company conditions affecting customer satisfaction.
Telecommunications Operator | Security Dispatcher
Christus Santa Rosa Hospital
San Antonio, TX
10.2018 - 01.2020
- Created, updated, and distributed the company directory to all departments
- Installed by management as the primary mentor and trainer for new employees
- Maintained a high-volume workload independently
- Handled an extremely high volume of 700-1000 calls per day
- Functioned as the emergency on-call person for all scheduling conflicts
- Operated and maintained an open line of communication via two-way radio with department heads
- Knowledgeable and Operated Microsoft Word, Microsoft Excel, and other Windows
- Software along with various office equipment within an executive office environment
- Communicated clearly and professionally with callers/patients and staff members to ensure high standard of satisfaction, loyalty, and retention
- Directed callers to appropriate departments or offices
- Communicate by making announcements and calls during an emergency
- Direct visitors and patients who need assistance
- Provided physical and psychological protection for all visitors, students, and employees
- Prepared incident reports, obtained written or oral statements, assisted local police agencies during investigations or emergencies
- Answered telephone calls to answer questions and provide information during non-business hours
- Tested communication and alarm systems, and reported malfunctions to maintenance units
- Monitored and authorized entrance and departure of employees, visitors, and other persons to guard against theft and maintain security of premises Maintained elaborate logs of scheduled details (fire watches)
- Called police and fire departments in cases of emergency
- Weekly post and
- Vacation scheduling using Microsoft Office
- Utilized 150+ cameras to oversee workers and crews within specified locations
- Directed incoming calls to internal personnel and departments, routing to best-qualified department.
- Performed clerical work such as sorting mail, restocking supplies and typing documents.
- Worked closely with network administrators and server engineers to deliver quality service.
- Analyzed user-generated trouble tickets to determine causes of problems and took appropriate action for resolution.
- Maintained up-to-date knowledge of emergency call procedures.
- Connected callers with appropriate professional, department or business.
- Attended safety training meetings to learn procedures for handling medical and fire emergency calls.
- Operated digital paging system to notify recipients of incoming calls.
- Developed expertise in communication systems cabling, circuitry and wiring through various projects for public utility companies.
- Planned layouts and ran cable into buildings and through walls, attics and crawl spaces.
- Read blueprints and schematics to correctly place equipment.
- Coordinated installation of new users and relocations of existing users.
- Responded to service requests during and after business hours.
- Set up networks and computers for business and residential customers.
- Researched and recommended network and data communications hardware and software.
Medical Office Specialist | Insurance Verification
Burnett's Staffing
San Antonio, TX
04.2015 - 08.2018
- Maintained a strong knowledge of basic medical terminology to better understand services and procedures
- Provided logistical support for programs, meetings, and events, including room reservations, room set- up, agenda preparation, materials printing and calendar maintenance
- Screened and sorted incoming mail, faxes, and deliveries and routed them to the appropriate personnel
- Escorted visitors to specific offices or meeting rooms
- Monitored and screened visitors to verify accessibility to inter-office personnel
- Contacted insurance carriers to discuss their policies and individual patient benefits
- Trained new hire staff on the referral and intake process
- Called insurance companies to get precertification and other benefits information on behalf of patients
- Completed up to 100 referral requests each day for a medical provider of
- Superior health Plan services
- Weighed patient need, provider availability and insurance coverage to determine optimal scheduling.
- Entered procedure codes and diagnosis codes into medical billing software.
- Adhered to strict HIPAA guidelines to protect patient privacy.
- Coordinated patient scheduling, check-in, check-out and payments for billing.
- Contacted patients regarding unpaid and underpaid accounts to resolve issues.
- Scheduled surgeries for multiple surgeons and booked operating rooms.
- Audited customer files to verify medical necessity and satisfaction of coverage criteria.
- Received, recorded and filed medical payments by check, cash and credit card.
- Managed office logistics by scheduling appointments, maintaining files and collecting payments.
- Scheduled patient appointments in respective doctors' calendars and followed up with reminder phone calls.
- Greeted visitors and initiated triage processes for clients to streamline patient flow.
- Organized and maintained patient chart filing system to promote quick data finding for staff.
- Placed new supply orders, managed inventory and restocked clerical spaces.
- Coordinated referrals through insurance and other medical specialists and documented details in patient charts.
- Registered and verified patient records before triage with most up-to-date information.
- Contacted hospitals to confirm patients medical histories and prevent inaccurate diagnoses and treatments.
- Completed administrative patient intakes with case histories, insurance information and mandated forms.
- Called and faxed pharmacies to submit prescriptions and refills.
- Gathered forms and copied insurance cards to collect patient information for billing and insurance filing.
- Improved timely payment of bills by developing flexible payment plans for patients.
- Restocked each medical room with adequate supply of medications and supplies in preparation for patients.
Collections Specialist
Conn’s Appliances
San Antonio, TX
11.2012 - 04.2015
- Worked in call center environment handling manual and automatically dialed outbound calls
- Ranked 5th on company scorecard out of 120 Collectors for 6 consecutive months
- Contacted customers to collect outstanding payments via one-time or negotiated installment methods
- Collected and arranged information and entered details into computer database
- Reviewed collection reports to determine the status of collections and the amounts of outstanding balances
- Applied training and persuasive communication strategies to overcome objections
- Used skip tracing and other techniques to locate debtors
- Monitored accounts for compliance with established payment plans
- Maintained a high volume of calls to meet demands of busy group
- Set up drafts and processed immediate payments
- Processed payments and applied to customer balances.
- Counseled debtors on payment options and arranged installment agreements.
- Monitored accounts for compliance with established payment plans and flagged non-compliances.
- Managed legal invoice processing for litigation by foreclosure attorneys.
- Used scripted conversation prompts to convey current account information and obtain payments.
- Trained new team members on scripts, company services and collection strategies.
- Used probing techniques to determine debtors' reasons for delinquency.
- Maintained high volume of calls and met demands of busy and productive group.
- Recorded all information regarding financial status of customers.
- Used skip tracing and other techniques to locate debtors.
- Processed payments and contracts on accounts.
- Managed post-petition payments for bankruptcy cases and worked with legal departments to determine appropriate proceedings.
- Worked in call center environment handling manual and automatically dialed outbound calls.
- Created documents for court such as affidavits, modifications and forbearance agreements.
- Discussed options with delinquent clients in terms of proposed solutions or foreclosure.
- Delivered exceptional customer service on collection calls and maintained calm and professional demeanor.
- Set up drafts and processed immediate payments after conducting thorough research and analysis of account.
- Helped clients plan payoffs for home equity, mixed-use and multi-family loans.
- Negotiated to collect balance in full.
- Collected documents and made portfolios for collections accounts.
- Researched accounts and completed due diligence to resolve collection problems.
- Achieved performance goals on consistent basis.
Fraud Prevention Specialist
Texas Health And Human Services | Xerox
San Antonio, TX
01.2011 - 11.2012
- Analyzed large amounts of data to find patterns of fraud and anomalies
- Collaborated with team members to discuss fraud trends and brainstorm methods to combat this type of crime
- Reviewed reports and individual transactions that appeared suspicious to uncover possible fraudulent activity
- Provided an exemplary level of customer service to all individuals, including clients and company personnel
- Educated customers on product and service details and information
- Documented all customer inquiries and comments thoroughly and quickly
- Alerted customers to upcoming sales events and promotions
- Coordinated between billing department and customers to resolve problems
- Asked open-ended questions to assess customer needs
- Gathered evidence, which included recorded and written statements, financial documentation, and audio materials for examination.
- Reviewed reports and individual transactions which appeared suspicious to uncover possible fraudulent activity.
- Interviewed witnesses thoroughly, asking appropriate questions to ascertain critical details about each case.
- Collaborated with team members to discuss fraud trends and brainstorm methods to combat this type of crime.
- Analyzed large amounts of data to find patterns of fraud and anomalies.
- Summarized all key information regarding investigation into detailed report for delivery to client.
- Gathered evidence, which included recorded and written statements, financial documentation and audio materials for examination.
- Contacted customers directly to notify of fraudulent activity and minimize impacts.
- Used critical thinking to break down problems, evaluate solutions and make decisions.
- Improved operations through consistent hard work and dedication.
- Worked with customers to understand needs and provide excellent service.
- Resolved conflicts and negotiated mutually beneficial agreements between parties.
- Devoted special emphasis to punctuality and worked to maintain outstanding attendance record.
- Worked to maintain outstanding attendance record, consistently arriving to work ready to start immediately.
- Exceeded goals through effective task prioritization and great work ethic.
- Developed and implemented performance improvement strategies and plans to promote continuous improvement.
- Drove operational improvements which resulted in savings and improved profit margins.
- Used Microsoft Word and other software tools to create documents and other communications.
Education
High school diploma -
South San Antonio High School ISD
08.2007 - 06.2010
Timeline
Member Debt Solutions
Apex Systems | USAA
11.2021 - 03.2022
Senior Medical Claims Examiner
WellMed
03.2020 - 11.2021
Telecommunications Operator | Security Dispatcher
Christus Santa Rosa Hospital
10.2018 - 01.2020
Medical Office Specialist | Insurance Verification
Burnett's Staffing
04.2015 - 08.2018
Collections Specialist
Conn’s Appliances
11.2012 - 04.2015
Fraud Prevention Specialist
Texas Health And Human Services | Xerox
01.2011 - 11.2012
High school diploma -
South San Antonio High School ISD
08.2007 - 06.2010
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Quote
There is a powerful driving force inside every human being that, once unleashed, can make any vision, dream, or desire a reality.
Tony Robbins
Skills
Member relationship management
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