Shalvina Chand
Sacramento,CA
Summary
To obtain a position as a team player in a people-oriented organization where I can maximize my professional background and maintain continuous improvements in providing excellent administrative and customer service delivery. Cooperative Correspondence Clerk with 7 years of experience. Adept at customer service and staying client focused through conflict resolution. Exceptional customer service skills and accurate typing ability.
Overview
14
14
years of professional experience
Work History
(Medicare/MedSupp) Correspondence Phone Support
Blue Shield Of CA
02.2024 - Current
- Resolve incoming calls concerning member's eligibility, benefits, provider information, monthly premium billing, clinical and pharmacy needs
- Compose routine and non-routine correspondence to answer benefits/provider inquiries in writing
- Coordinate membership changes such as member's primary care physician
- Perform routine to mid-level inventory reduction (i.e., member inquiries, may initiate claim adjustments, respond to emails, etc.)
- Review and analyze member claims for accuracy as well as member education on how benefits are applied
- Proactively analyze available programs, determine program eligibility and connect Members to appropriate BSC vendors, Health Advocates, Social Workers, Pharmacy Techs, and Pharmacists.
- Comprehensive resolution of pharmacy calls concerning benefits coverage, co-pays, formulary coverage, vacation overrides, and utilization management requirements.
Enrollment Agent
Maximus Federal Services
08.2021 - 10.2023
- Essential Duties and Responsibilities:
Answer incoming calls from consumers including general public, prospective enrollees and people assisting enrollees or acting on their behalf in accordance with all performance standards, policy and procedures, and protocols including but not limited to confidentiality and privacy policies. - Track and document all inquiries using applicable systems.
- Complete associated tasks according to established guidelines.
- Track and document all inquiries using applicable systems.
- Meet Quality Assurance (QA) and other key performance metrics.
- Facilitate fulfillment of caller requests for materials via mail, email, or download.
- Transfer/refer consumers to appropriate entities according to established guidelines.
- Escalate calls or issues to appropriate designated staff for resolution as needed.
- Facilitate translation services for non-English speaking callers according to procedures.
- Attend meetings and training as requested and maintain up-to-date knowledge of all programs and systems.
Franchise Owner
Coverall
04.2017 - 03.2021
- Performed building cleaning and maintenance of office and building facilities throughout Elk Grove area.
- Hired and trained employees to assist me in performing these duties.
- Met with clients on regular basis to ensure contract was being performed to their satisfaction.
- Consulted with customers to assess needs and propose optimal solutions.
Information Specialist
Better Business Bureau
01.2015 - 02.2018
- Responsible for answering all phone lines and providing information requested to include business reviews, referrals to appropriate agencies or staff and general advice on consumer related topics.
- Update business records with current information to include business start date, names of principals, type of business classification, URL, email address and licensing.
- Input responses and new complaints that are received by walk-ins, fax and/or mail, complete at least 4 investigations weekly, input closed arbitration details into system when needed.
- Complete license check monthly to insure that all AB's have updated their license, send out license letter correspondence and notify appropriate staff as required.
Patient Registration Representative
Mercy General Hospital
02.2013 - 12.2015
- Collected payments and co-pays from customers using large variety of insurance programs, adjusting amounts based on specific plan directives.
- Explained financial responsibilities to patients as well as payment options and potential collection procedures imposed upon patients and other responsible parties.
- Set up patients in system by documenting key data, confirming eligibility and verifying insurance benefits.
- Received and routed laboratory results to correct clinical staff members.
Access Control Specialist
GOOGLE INC
05.2010 - 11.2012
- Audit vendor & contractor lists for security verification prior to giving access to the facilities and other restricted areas.
- Create picture badges for new hire employees, interns, contractors and vendors.
- Monitor approval process for any temporary badges for day pass or monthly passes.
- Use ticketing system and chat bots to give customer service to the employees globally and resolve issues.
Education
High School Diploma -
Laguna Creek High School
Elk Grove, CA06.2007
Some College (No Degree) - Criminal Justice
ITT Technical Institute
Rancho Cordova, CASkills
- Adaptable in fast paced environment
- Works well under pressure
- Able to perform without extensive directions
- Comfortable working independently
- Productive and cooperative team-player
- Reliable and consistent
- Organized and flexible
- Analytical
Timeline
(Medicare/MedSupp) Correspondence Phone Support
Blue Shield Of CA
02.2024 - Current
Enrollment Agent
Maximus Federal Services
08.2021 - 10.2023
Franchise Owner
Coverall
04.2017 - 03.2021
Information Specialist
Better Business Bureau
01.2015 - 02.2018
Patient Registration Representative
Mercy General Hospital
02.2013 - 12.2015
Access Control Specialist
GOOGLE INC
05.2010 - 11.2012
High School Diploma -
Laguna Creek High School
Some College (No Degree) - Criminal Justice
ITT Technical Institute
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