Shelia Jenkins
Kissimmee,FL
Summary
Customer Service Representative with over 15 years of experience in a call center setting, with customer care and support, familiar with major customer care software, conflict resolution, and possess a positive attitude. I am aiming to use my proven skills to effectively resolve resolutions. Enhance customers experiences by employing service-oriented behaviors, understanding customer desires, ad providing customized solutions to build loyalty.
Overview
12
12
years of professional experience
Work History
Customer Service Representative (Remote)
DentaQuest
11.2021 - 02.2022
- Assisted member with eligibility; Assisted with locating a provider
- Provided information on claim status, requested ID card, changed providers, and assisted with appeal and authorizations
- Provided benefits along with copays, coinsurance, deductible
- Created customer appointments
- Provided excellent technical support.
- Handled customer inquiries and suggestions courteously and professionally.
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
Benefit Verification Specialist (Remote)
Talent Bridge/ Lash Group
11.2020 - 02.2021
- Verifies patient specific benefits and precisely documents specifics for various payer plans including patient coverage, cost share, and access/provider options
- Identifying any coverage restrictions and details on how to expedite patient access
- Documenting and initiating prior authorization process and claims appeals
- Reporting any reimbursement trends or delays to management
- Contact insurance companies and ask appropriate questions regarding a patient's benefits and complete data entry and/or appropriate forms to document patient benefits coverage.
Pharmacy Service Representative
CVS Health
02.2019 - 08.2019
- Coordination and processing of new patient medication orders and reorders, which includes verifying and re-verifying
- Translating and entering new or refill prescriptions into the pharmacy information system, communicating and collecting copayments
- Obtaining authorizations, working with insurance companies, healthcare providers and/or internal teams to screen, identify, resolve and defer orders that have accounts receivable or clinical issue
- Use your superb communication skills to contact the doctor's offices and insurance companies to ensure the accuracy of our patient's specialty medication orders
- Provides timely and thorough follow-up with internal and external customers
- Data entry processing of specialty medications.
Client Service Representative-(Remote)
Employees Benefits Management Services
09.2018 - 02.2019
- Receives and responds to customers' inquiries regarding their plan documents, benefits, and claims
- Identifies, researches, and resolves customer issues and accurately enters the data into the appropriate documentation system
- Routes calls and emails to appropriate person
- Provides timely and thorough follow-up with internal and external customers.
Policy Support Specialist (Remote)
Horizon Blue Cross Blue Shield of New Jersey
12.2009 - 01.2018
- Research medical records to resolve claims or service requests that pend with clinical edits for all lines of business
- Review medical policies and determine the appropriate claim processing or clinical review process decisions
- Coordinate the clinical review and appeal processes including; preparing cases for clinical review and requesting additional information from members and providers
- Review clinical determinations and initiate appropriate claim adjustments and service requests closeout, including drafting manual letters
- Identify technical issues and submit them to the appropriate area for resolution in compliance with HIPAA (Health Insurance Portability and Accountability Act) policies and regulations
- Review and update Coordination of Benefit (COB) files and submit provider file updates as necessary
- Review patient medical records and utilize clinical and regulatory knowledge and skills swell as knowledge of payer requirements to determine why cases are denied and whether an appeal is required.
Education
High School Diploma -
Theodore Roosevelt High School
Bronx, NY06.1978
Skills
- HIPAA
- Medisoft
- Microsoft Word
- Efficient and reliable team player
- Excellent communication skills
- Strong analytical and critical thinking
- GBAS (Group Benefits Administration Mixie Software Phone System System)
- Customer Service
- Problem-solving abilities
- Active Listening
- Problem Resolution
- Call center experience
- Computer Proficiency
- Microsoft Outlook
Work Preference
Work Type
Part TimeWork Location
RemoteImportant To Me
Paid sick leaveTimeline
Customer Service Representative (Remote)
DentaQuest
11.2021 - 02.2022
Benefit Verification Specialist (Remote)
Talent Bridge/ Lash Group
11.2020 - 02.2021
Pharmacy Service Representative
CVS Health
02.2019 - 08.2019
Client Service Representative-(Remote)
Employees Benefits Management Services
09.2018 - 02.2019
Policy Support Specialist (Remote)
Horizon Blue Cross Blue Shield of New Jersey
12.2009 - 01.2018
High School Diploma -
Theodore Roosevelt High School
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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