Summary
Overview
Work History
Education
Skills
Timeline
Generic
Shelessia Wiley

Shelessia Wiley

Groesbeck,TX

Summary

Knowledgeable and dedicated with extensive experience in Customer Service, Data Entry, Technology and Problem Solving. Solid team player with outgoing, positive demeanor and proven skills in establishing rapport with clients. Motivated to maintain customer satisfaction and contribute to company success. Specialize in quality, speed and process optimization.


Gifted in working with stressed, confused and upset individuals in need of benefits information and supportive guidance to navigate systems. Effective at operating within all regulations and department guidelines to manage telephone calls, emails, chats, letters and in-person requests for assistance.

Overview

10
10
years of professional experience

Work History

Care Review Processor

Molina Healthcare
12.2022 - 11.2023
  • Conducted authorization requests and provider inquiries by phone, mail or fax to verify member eligibility and benefits.
  • Maintained confidentiality of client records to comply with HIPAA guidelines.
  • ICD & Billing Codes, Diagnosis & Treatments Request
  • Benefits & Status Determination. Assisted with medical coding and billing tasks.

Patient Resolution Specialist

HBCS
12.2021 - 12.2022
  • Maintained confidentiality of client records to comply with HIPAA guidelines.
  • Manage high volume of in-bound and out-bound calls from patients, hospitals, and insurance carriers to resolve patient accounts, collect payment, and data entry
  • Ensure protection of patient privacy and compliance with State and Federal guidelines
  • Drove dispute resolutions using effective problem-solving and by guiding mutual understanding of opposing viewpoints.

Customer Service Representative

Solid State Operations
08.2020 - 12.2021
  • Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
  • Answered constant flow of customer emails and chats with minimal wait times..
  • Used company troubleshooting resolution tree to evaluate technical problems and find appropriate solutions.
  • Delivered exceptional customer service to every customer by leveraging extensive knowledge of products and services and creating welcoming, positive experiences.

Customer Service Representative

Navient
01.2018 - 06.2020
  • Reviewed applications for different aid programs and determined which qualification criteria for individuals.
  • Interviewed applicants and explained scope of different available benefits.
  • Scheduled appointments with applicants to gather information and explain benefits processes.
  • Assisted with additional information regarding unemployment claims, and benefits

Customer Service Representative

General Dynamics Information Technology
01.2014 - 12.2017
  • Responded to support requests from end users and patiently walked individuals through basic troubleshooting tasks.
  • Managed customers' expectations of support and technology functionality in order to provide positive user experience.
  • Conducted in-depth product and issue resolution research to address customer concerns.
  • Followed up with clients to verify optimal customer satisfaction following support engagement and problem resolution.

Education

Associate of Arts - Criminal justice

Hill College
Hillsboro, TX

High School Diploma -

Groesbeck High School
Groesbeck, TX
06-2014

Skills

  • Computer Skills
  • Software
  • Multitasking
  • Working Independently
  • Good listening skills
  • Computer proficiency
  • Excellent work ethic
  • Inbound and Outbound Calling

Timeline

Care Review Processor

Molina Healthcare
12.2022 - 11.2023

Patient Resolution Specialist

HBCS
12.2021 - 12.2022

Customer Service Representative

Solid State Operations
08.2020 - 12.2021

Customer Service Representative

Navient
01.2018 - 06.2020

Customer Service Representative

General Dynamics Information Technology
01.2014 - 12.2017

Associate of Arts - Criminal justice

Hill College

High School Diploma -

Groesbeck High School
Shelessia Wiley