Summary
Overview
Work History
Education
Skills
Timeline
Generic

SHANICE LINNEN

Fuquay-Varina,NC

Summary

Personable Customer Service Professional with experience in management, claims and call-center operations. The ability to print, scan, email and distribute documents via special mail as needed Ability to identify customers’ needs and offer company resources and services. Demonstrated talent to resolving escalated customer service issues. Able to Identify and participate in projects and improvements initiatives Respectful of client’s privacy as dealing with sensitive documents Exquisite eye for detail Skilled Picker Packer operating on feet for extended periods to manage large number of packages every shift. Well-organized, reliable and hardworking with solid record of exceptional productivity.

Overview

17
17
years of professional experience

Work History

MIPS Agent

Cotiviti, Draper Utah
06.2022 - 12.2022
  • Reviewing and associating medical records to the appropriate requests while maintaining adequate production and quality levels through tracked metrics
  • Review medical records and associate individual records to the correct location for client downloading
  • Perform quality checks prior to associating each record for download, ensuring all protected health information is safeguarded in the client record
  • Responsible for identifying incoming invoices and providing the PIQ lead
  • Process incoming authorizations for request of records in a timely manner as outlined by Verscend process
  • Completing all responsibilities as outlined on annual Performance Plan
  • Completing all special projects and other duties as assigned
  • Maintain quality at or above 98.0% Processing a minimum level of back-end treatment forms as required
  • Reviews MNR forms to be sure all information is complete
  • Verifies member eligibility and creates patient records
  • Checks patient and provider information on Verscend Forms
  • Forwards inaccuracies to the Clinical Quality Evaluators’ designated bins for escalation
  • Retrieves patient files or history for the provider
  • Reviews patient information worksheets to make sure they are complete
  • Inputs all required data from worksheets into Aetna Health Care System
  • Proofs claim or referral submission to determine, review, or apply appropriate guidelines, coding, member identification processes, provider selection processes, claim coding, including procedure, diagnosis and pre-coding requirement

Administrative Specialist II

Of Motor Vehicles
04.2019 - 04.2021
  • Providing information pertaining to vehicle titling and licensing, driver license services, liability insurance, and safety/emissions inspections to the public
  • Promptly responds to incoming chats within the standard greeting approved timeframe
  • Performs appropriate research in internal databases and online to identify potential providers and resources
  • Maintains accurate and complete internal documentation of required information that meets risk management and regulatory requirements
  • Agent will triage calls in a in a professional and timely manner if needed
  • Performed in a fast paced, performance-based call center environment responding to inquiries via phone and e-mail
  • Aiding customers in resolving complex issues unresolved by automated voice processing equipment, providing comprehensive and detailed information, and preparing reports
  • Provides miscellaneous support functions including administrative support, follow-up calls, and other duties as assigned
  • Storing, managing and track records and documents via special mail such as FedEx and USPS
  • Giving responses learned and performed in accordance with DMV rules and regulations and the Privacy Protection Act
  • This position was temporarily remote from April 2020 until April 2021
  • Created and updated records and files to maintain document compliance.
  • Delivered top-notch administrative support to office staff, promoting excellence in office operations.
  • Created and updated physical records and digital files to maintain current, accurate, and compliant documentation.
  • Resolved customer concerns efficiently to promote satisfaction and loyalty.
  • Handled incoming and outgoing mail.

Administrative Specialist

Motor Vehicles, North, Il
04.2018 - 04.2019
  • Extracting and inspecting mail order applications and entering information into the State Automated Registration System (STARS) for creating, updating and/or modifying registration records
  • Collecting fees and balancing transactions and cash drawers
  • Operating and performing data entry via Remittance Processor
  • Storing, managing and track records and documents via special mail such as FedEx and USPS
  • Researching and resolving rejections from error reports received from the internet and remittance processor, processing refunds and various registration requests and applications
  • Creating correspondence to the motoring public.
  • Created and updated physical records and digital files to maintain current, accurate, and compliant documentation.

Processing Assistant IV

Of Motor Vehicles, North
03.2018 - 04.2018
  • Responsible for answering general questions about policies and procedures regarding hearing eligibility and scheduling; the date, time, and location of hearings that have been scheduled; and the status of cases
  • This position will be responsible for preparing reports and composing correspondence using existing form letters and templates
  • This position is required to send and track correspondence and documents sent to all parties associated with the hearing via certified mail
  • Position may transcribe recordings of hearings proceedings at the request of the Commissioner and/or the Attorney General
  • When appropriate, the position will be responsible for purging and archiving files
  • This position will be responsible for processing mail received by the License & Theft Scheduling staff within the Problem Resolution/Adjudication Unit
  • This position may be asked to perform other duties to support the operations of the Problem Resolution/Adjudication Unit
  • Assist with handling all cases generated as a result of actions taken by the License and Theft Bureau.
  • Prioritized initiatives to increase success rates of strategic projects.
  • Developed standard operating procedures and document workflows to drive current and future processes.
  • Analyzed process flows and identified areas of improvement to increase productivity and reduce costs.
  • Developed production techniques and production processes to meet customer and organizational needs.
  • Monitored and reported on process performance to verify compliance with established standards.

Processing Assistant lll

Motor Vehicles, North
07.2017 - 03.2018
  • Receiving records, examining and preparing incoming documents from License Plate Agencies and On-line Dealers
  • Ensures documents are free from objects such as paper clips and staples to properly run through high-speed scanning systems
  • Storing, managing and track records and documents via special mail such as FedEx and USPS

Customer Service Representative

Sykes
06.2014 - 07.2016
  • Specializing in escalated inbound calls from AT&T customers
  • Trouble shooting, billing, online help, providing great customer service
  • Assessing payment plans for customers effected by Hurricane Matthew
  • Provides legendary Customer Service by effectively communicating with Customers via telephone and electronic channels (including but not limited to social media) while following the AT&T Expectations
  • Customer Service Representatives must efficiently and properly resolve Customer concerns
  • Answered constant flow of customer calls with minimal wait times.
  • Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
  • Handled customer inquiries and suggestions courteously and professionally.

Processing Assistant V

Of Revenue
02.2011 - 03.2013
  • Assist in the Extract and sort unit of document processing by repair of scanning Preparing and processing withholdings from store owners for alcohol and tobacco
  • Storing, managing and track records and documents via special mail such as FedEx and USPS
  • Processing registration payments for alcohol and tobacco
  • Assisting tax's payers with inquiries regarding payments and payment options
  • Analyzed process flows and identified areas of improvement to increase productivity and reduce costs.
  • Developed standard operating procedures and document workflows to drive current and future processes.
  • Monitored and reported on process performance to verify compliance with established standards.

Customer Service Representative

Aetna Health Care
09.2008 - 03.2009
  • Answer phone calls and update customer’s personal information for Aetna health insurance
  • Responding to telephone inquiries and complaints for insurance claims
  • Research, and review and process health insurance claim information
  • Entering clinical reports and data directly into customer EHRs, adhering to specific clinic guidelines and workflows
  • Assess customer needs and Informs customers about services available
  • Assists in planning and implementing department goals for efficiency and effectiveness
  • Applying medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and applies all cost containment measures to assist in the claim adjudication process
  • Coordinates responses for routine phone inquiries and written correspondence related to claim processing issues
  • Processing credit listing functions, aged listings and held claims
  • Processing adjustments by working with ambulance services, inpatient facility services and others
  • Determine whether to return, deny or pay claims following contract benefit and organizational processing guidelines. Perform additional research to develop claims; includes contacting providers or members. Provide customer service and education to plan members and providers by answering more complex questions regarding insurance claims and policies, resolving issues and ensuring customers understand the Company’s products, services and processes
  • Perform research to respond to inquiries and interpret policy provisions to determine most effective response. Use computerized systems for tracking, information gathering and troubleshooting. Actively seek, identify and implement process improvement opportunities. Perform other duties as assigned
  • Routes and triages complex claims to Senior Claim Benefits Specialist
  • Answered constant flow of customer calls with minimal wait times.
  • Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.

Processing Assistant

Department of Revenue
02.2006 - 01.2008
  • Assist in the Extract and Sort unit of document processing by preparing documents for scanning
  • Capturing data images to be posted to department databases
  • Open high volumes of incoming mail during tax season
  • Storing, managing and track records and documents via special mail such as FedEx and USPS.
  • Analyzed process flows and identified areas of improvement to increase productivity and reduce costs.
  • Developed standard operating procedures and document workflows to drive current and future processes.
  • Developed production techniques and production processes to meet customer and organizational needs.

Customer Care Representative

Humana
08.2007 - 10.2007
  • Answer inbound calls mostly for prescription drug plan (Medicare D), which ranged from routine balances and history transactions to complex problems requiring a great deal of research
  • Updating the system with relevant information including transactions related to each customer contact
  • Entering clinical reports and data directly into customer EHRs, adhering to specific clinic guidelines and workflows
  • Maintain a high-quality standard and adhere to account-specific documentation which delineates documentation requirements for our customers
  • Making calls on delinquent accounts and offer different packages to assist them in getting current on payments
  • Performing other duties as assigned by supervisor.

Customer Service Representative

Centralized Showing Services
04.2007 - 08.2007
  • Assisting Real Estate agents to show homes to potential buyers
  • Assisting borrowers with resources for knowledge of FNMA, FHLMC, FHA, VA, local bonding programs, and private investors
  • Receive incoming calls and make calls for clients to establish showing their home
  • Provide service dates for homeowners, making sure all required information is correct in database
  • Schedule, reschedule, and cancel home showings at clients or agents request making sure all particulars are given
  • Availability to handle customer inquiries at schedule times and fax required documents when necessary to (i.e., pets secured or not) meet
  • Complete listing viewings.

Retail Team Member

Target
08.2006 - 11.2006
  • Make sure each customer received outstanding service by greeting and acknowledge every customer
  • Assist in completing price changes within the department per manages’ request
  • Participate in inventory and cycle counts as required by management
  • Assist in processing and stocking up merchandise and monitoring floor stock.

Education

High School Diploma -

Wakefield High School
Raleigh, North Carolina

in the Medical Billing and Coding Program -

Piedmont Central Community College
2023

Skills

  • Specification Compliance
  • Rewards Programs
  • Local Road Knowledge
  • Accurate Weights
  • Team Meetings
  • Quality Inspections
  • Safety Protocols
  • Special Projects
  • Video Conference Preparation
  • Organizational Management
  • Event Coordination

Timeline

MIPS Agent

Cotiviti, Draper Utah
06.2022 - 12.2022

Administrative Specialist II

Of Motor Vehicles
04.2019 - 04.2021

Administrative Specialist

Motor Vehicles, North, Il
04.2018 - 04.2019

Processing Assistant IV

Of Motor Vehicles, North
03.2018 - 04.2018

Processing Assistant lll

Motor Vehicles, North
07.2017 - 03.2018

Customer Service Representative

Sykes
06.2014 - 07.2016

Processing Assistant V

Of Revenue
02.2011 - 03.2013

Customer Service Representative

Aetna Health Care
09.2008 - 03.2009

Customer Care Representative

Humana
08.2007 - 10.2007

Customer Service Representative

Centralized Showing Services
04.2007 - 08.2007

Retail Team Member

Target
08.2006 - 11.2006

Processing Assistant

Department of Revenue
02.2006 - 01.2008

High School Diploma -

Wakefield High School

in the Medical Billing and Coding Program -

Piedmont Central Community College

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SHANICE LINNEN