Sermekia Harclerode
EAST ORANGE,NJ
Summary
19 Years of dedicated Customer Service Experience. I am a reliable and motivated candidate. I strive on maintaining customer satisfaction while meeting above expectations of daily/monthly metric goals, as my contribution to company success. I have a proven track record of long-lasting business relationships with internal & external clients, were as though services provided has exceed expectations. Strong communication skills including time management and prioritization abilities.
Overview
22
22
years of professional experience
Work History
CUSTOMER SERVICE REPRESENTATIVE II
CONNECTIVE RX
12.2021 - Current
- Provide accurate and thorough explanation of benefits, eligibility, resolving customer inquiries, facilitating problem resolution and acting as a member / provider advocate by meeting or exceeding customer expectations
- Achieve and maintain productivity and quality performance expectations
- Interpret and effectively communicate benefits and eligibility information to our customers
- Ensuring all critical information related to clientele interaction is updated accordingly in the MHS system while navigating through multiple complex systems
CUSTOMER SERVICE REPRESENTATIVE
HORIZON BEHAVIORAL HEALTH
04.2018 - 05.2021
- Company Overview: Position held within Beacon Health Options
- Provided accurate through explanation of benefits and eligibility to policy holders
- Providing one call resolutions for consumer inquiries regarding billing, claims processing, provider search, plan selection assistance
- Serving as a provider advocate to facilitate claim processing resolutions for policy holders while maintaining company standards and protocol
- Achieve and maintain productivity and quality performance expectations
- Position held within Beacon Health Options
CUSTOMER SERVICE REP (TEM)
CLOVER
09.2016 - 12.2017
- Processing and monitor all payment processing, claims processing, and filing consumer disputes and responses using various databases
- Facilitating authorizations for providers and facilities while supplying detailed information of member benefits and eligibility according to company protocol
CLAIMS/CUSTOMER SERVICE REP
HORIZON BCBSNJ
01.2003 - 05.2014
- Taking inbound calls from various providers regarding medical claim assistance
- Performing client research of complex medical claim issues or unpaid claims with providers, facilities, and member reimbursements
- Ensuring day to day task and follow up to claims are completed within a timely manner by using company provided tools to investigate claims
- Placing members and clients with resources for available services, programs and referrals when necessary
Education
HS Diploma - Business Administration
East Orange Campus High School
06.1998
Skills
- MS OFFICE (Word, Excel, Power Point)
- MHS Systems
- Claims processing
- Aspect Teleset
- Avaya soft phone
- Cisco Finesse
- GENESYS
- Payroll
- Cashier
- Comtrac
- E-time
- Workday
- Customer Service
- Detailed oriented
- Self-starter
- Medical billing & coding
- Medical Terminology
- General Office Skills
- MS Teams
- Proactive Team player
- Critical thinker
- Active listening skills
Timeline
CUSTOMER SERVICE REPRESENTATIVE II
CONNECTIVE RX
12.2021 - Current
CUSTOMER SERVICE REPRESENTATIVE
HORIZON BEHAVIORAL HEALTH
04.2018 - 05.2021
CUSTOMER SERVICE REP (TEM)
CLOVER
09.2016 - 12.2017
CLAIMS/CUSTOMER SERVICE REP
HORIZON BCBSNJ
01.2003 - 05.2014
HS Diploma - Business Administration
East Orange Campus High School
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