Shequaysia Tolliver

• Delivered customer service by addressing inquiries, resolving complaints, and offering detailed information on healthcare services to enhance client understanding.
• Guided members through provider searches, referrals, and appointment questions.
• Verified patient demographic information to ensure accurate data entry, supporting efficient patient management and service accuracy.
• Coordinated with billing, coding, and clinical documentation specialists to streamline processes and improve overall service delivery.
• Generated monthly performance metrics reports based on customer feedback survey results.

• Explained insurance benefits, claims details, and eligibility questions clearly.
• Assisted in verifying patient insurance eligibility before appointments to facilitate seamless service.
• Collected and accurately entered patient payments into the billing system, ensuring timely processing.
• Processed paperwork related to medical claims processing including authorizations, referrals, pre-certifications.
• Verified patient information and updated service records to ensure accuracy and compliance.

• Managed inbound customer calls for Solix account support, ensuring timely and effective resolution of inquiries.
• Answered customer inquiries and provided accurate information regarding products and services.
• Processed account changes and customer requests accurately
• Collected customer feedback through surveys to identify service improvement opportunities.
• Documented interactions and case notes for Solix clients to maintain accurate service records.

• Explained insurance benefits, claims details, and eligibility questions clearly.
• Resolved billing concerns and account issues through healthcare support workflows.
• Guided members through provider searches, referrals, and appointment questions.
• Checked patient insurance eligibility before appointments to ensure coverage clarity.
• Verified patient information and updated records in service systems.
• Collected and accurately entered patient payments into billing system, maintaining financial accuracy.
• Escalated complex complaints to supervisors and client support teams for effective resolution.
• Collaborated with billing, coding, and clinical documentation improvement specialists.

• Managed inbound customer calls for Solix account support, addressing inquiries and providing assistance.
• Answered customer inquiries and provided accurate information regarding products and services.
• Provided excellent customer service to resolve customer complaints in a timely manner.
• Clarified customer service needs through probing questions and documented information accurately in electronic systems.
• Resolved billing and service questions using Solix procedures
• Escalated complex issues to specialized teams for timely resolution, ensuring customer satisfaction.

CUSTOMER ADVOCATE, AEGIS  Accept incoming calls and conduct outgoing calls to policyholders to assist with questions regarding coverage under a health insurance policy.  Processed coverage requests for services under health insurance plans to ensure policyholder access to benefits. MEMBER RETENTION REPRESENTATIVE  Conduct outgoing phone calls to current and previous member to educate on the changes in policy they were assigned to  Transferred to sales when policyholder wanted to sign up for a new policy or had questions regarding other policies available. SME (Subject Matter Expert)  Provide side by side assistance for advisors when guidance is needed answer customers questions and concerns  Take over escalation calls when advisor isn’t able to address customers concerns or fulfill customers request APPEALS &GRIEVANCE CHAMP  Review advisor submissions for coverage determination, appeals and grievance on customer's behalf.  Sign off on advisor submissions when completed correctly according to template and guidelines outlined

• MEMBER RETENTION REPRESENTATIVE Conduct outgoing phone calls to current and previous member to educate on the changes in policy they were assigned to Transferred to sales when policyholder wanted to sign up for a new policy or had questions regarding other policies available.
• SME (Subject Matter Expert) Provide side by side assistance for advisors when guidance is needed answer customers questions and concerns Take over escalation calls when advisor isn’t able to address customers concerns or fulfill customers request
• APPEALS &GRIEVANCE CHAMP Review advisor submissions for coverage determination, appeals and grievance on customer's behalf. Sign off on advisor submissions when completed correctly according to template and guidelines outlined

• - Reviewed past-due accounts and analyzed payment history to identify collection opportunities.
• - Set up payment plans within company collection guidelines.
• Facilitated customer payments, ensuring account accuracy and timely updates to records.
• - Assisted customers with inbound calls regarding collections and billing questions.
• - Clarified account balances, statements, and due dates for customers.
• Documented call notes in customer account systems to maintain comprehensive account histories.