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
Conflict Resolutions
Debt collection processes
Member education
Member enrollment
Collaborating with team members
Supply solutions development
Credit solutions guidance
E-service solutions
Training solutions development
Complaint resolution
Sales expertise
Training development aptitude
Service standard compliance
CRM
Staff education and training
Account management
Creative problem solving
Recordkeeping strengths
Microsoft Office Suite
Valuation knowledge
Healthcare Common Procedures Coding System (HCPCS)
Underwriting knowledge
Legal proceedings knowledge
Policy investigations
Insurance billing procedures
Healthcare coding
Follow-up skills
Understanding of medical ethics
Insurance billing
Prior authorization processing
Patient contact
Insurance coverage verification
Excellent Communication
Problem-Solving
Active Listening
Multitasking Abilities
Planning and Coordination
Decision-Making