Summary

Overview

Work History

Education

Skills

Timeline

Shadacia Hines

Arlington,TX

Summary

Personable and dedicated Customer Service Representative with extensive experience in the call center industry. Solid team player with upbeat, positive attitude and proven skill in establishing rapport with clients. Motivated to maintain customer satisfaction and contribute to company success. Articulate, enthusiastic and results-oriented with demonstrated passion for building relationships, cultivating partnerships and growing businesses.

Overview

years of professional experience

Work History

Claims Representative

UnitedHealthcare

Remote

08.2022 - Current

Reached out to provider's Facility/Billing department to verify claim information & payment status.
Emailed members to inform claims have been reprocessed & can view claim information & Explanations of benefits through companies app.
Updated Coordination Of Benefits with members & 3rd party companies to ensure successful claim processing correctly.
Located & researched CPT, HCPCS, and/or ICD-10 for copay cost for members & providers & to adjust a claim that has billing code errors.
Operated OPTUMRX system to provide members with coverage information on prescriptions & pharmacy's.
Provided medical & prescription Prior Authorization status to providers & members.
Provided appeal information & status
Provided members with CAA letters to show providers are in network or out of network.
Worked productively in fast-moving work environment to process large volumes of claims.
Followed up with customers on unresolved issues.
Improved customer satisfaction by providing timely and accurate information on claim status and resolution.
Maintained compliance with industry regulations by adhering to established procedures and guidelines in claims handling.
Developed strong relationships with clients, facilitating trust and open communication during the claims process.
Collaborated with cross-functional teams to expedite complex claims investigations and resolutions.
Investigated and resolved complex claims, ensuring adherence to policy guidelines and regulatory compliance.

Remote CSR

Iqor

REMOTE

07.2019 - 05.2023

Answered incoming calls and provided highest level of professionalism and knowledgeable service to every customer.
Demonstrated empathy and active listening skills, resulting in a higher rate of customer satisfaction and repeat business.
Answered customer telephone calls promptly to avoid on-hold wait times.
Assisted customers with account set-up, enabling smooth transitions into using the company''s products or services.
Answered, screened and processed high volume of calls daily with call management system and web-based communications.
Maintained strong call control and quickly worked through scripts to address problems.
Updated customer accounts, addresses and contact information within call management databases.
Asked probing questions to determine service needs and accurately input information into electronic systems.
Resolved customer inquiries, questions and concerns to consistently offer quality service and meet performance benchmarks

Customer Service Representative

USAA Federal Savings Bank

Remote

09.2017 - 04.2019

Managed high-volume of inbound and outbound customer calls.
Resolved customer inquiries, questions and concerns to consistently offer quality service and meet performance benchmarks.
. Handled customers effectively by identifying needs, quickly gaining trust, approaching complex situations and resolving problems to maximize efficiency.
Maintained strong call control and quickly worked through scripts to address problems.
Coordinated with various company teams to offer and implement successful solutions to customer problems.
Processed customer account changes with proprietary software.
Promoted product offerings to drive growth and exceed benchmarks.
. Audited custom.

Inbound Call Center Representative

Nickson Living

Irving, TX

03.2015 - 08.2017

Answered phones to respond to customer inquiries and transferred calls to appropriate staff members.
Welcomed patrons to front desk and engaged in friendly conversations while conducting check-in process.
Handled payment processing and provided customers with receipts and proper bills and change.
Provided administrative support to coworkers, taking on additional tasks during high-volume periods.
Managed customer complaints and rectified issues to complete satisfaction.
Collaborated with staff to meet incoming guest needs, smooth check-in processes and maximize satisfaction.
Took inventory and ordered low-stock items to maintain effective supply organization.
Maintained important files, running reports and delivering updates on occupancy and revenue.
Engaged directly with clients to fulfill requests, resolve conflicts and direct non-customer service related inquiries to appropriate department and personnel.
Built relationships with long-term clients through individualized and outstanding customer service.