Sheree Pyles
Detroit
Summary
Experienced and dedicated customer service professional with over 20 years of providing exceptional service. Strong track record in leading teams and utilizing analytical abilities for effective problem-solving. Possesses excellent phone etiquette and a natural talent for troubleshooting and resolving complex issues. Creative individual with a knack for utilizing technology and resolving claim problems. Highly organized, detail-oriented, and a quick learner. Eager to contribute and excel in any work environment.
Overview
27
27
years of professional experience
1
1
Certification
Work History
Tier 2 Customer Service Claims Representative
Blue Cross And Blue Shield Of Michigan
09.2024 - Current
- Utilized problem-solving skills to address customer complaints.
- Improved customer satisfaction by actively listening to concerns and providing prompt resolutions.
- Maintained detailed records of customer interactions for accurate tracking and analysis of trends or recurring issues.
- Provided comprehensive product knowledge to address customer questions confidently and accurately.
- Improved customer satisfaction by providing timely and accurate information on claim status and resolution.
- Maintained compliance with industry regulations by adhering to established procedures and guidelines in claims handling.
- Developed strong relationships with clients, facilitating trust and open communication during the claims process.
- Collaborated with cross-functional teams to expedite complex claims investigations and resolutions.
- Provided exceptional customer service, addressing concerns and resolving issues promptly.
- Investigated and resolved complex claims, ensuring adherence to policy guidelines and regulatory compliance.
Provider Relations Representative
Blue Cross and Blue Shiel of Michigan
03.2023 - 09.2024
- Assisted providers in navigating through various reimbursement processes, resulting in timely payments and reduced financial disputes between parties.
- Strengthened provider networks through regular outreach and relationship building activities.
- Served as a liaison between healthcare organizations and insurance companies to ensure seamless communication regarding claims processing and payment matters.
- Managed high-volume caseloads of dispute resolution cases, providing swift resolutions that maintained positive relationships with both parties involved.
- Researched and resolved disputes, billing discrepancies, and claims efficiently to maintain customer satisfaction, boosting satisfaction ratings .
- Answered provider inquiries via email, telephone and written correspondence.
- Managed provider relations mailbox by triaging inquiries, facilitating resolution of incoming requests and forwarding requests to appropriate parties.
- Reduced claim disputes by effectively communicating policy changes and updates to providers.
- Provided exceptional customer service when working directly with healthcare professionals, establishing a reputation as a trusted resource for assistance.
- Enhanced provider satisfaction by addressing and resolving inquiries in a timely manner.
- Resolved customer complaints using established follow-up procedures.
- Verified patient insurance eligibility.
Email Response Technician
Apple inc.
08.2017 - 05.2022
- At home Apple email response technician
- Provide great customer service
- Generate email correspondence to customers
- Provide product information and updates via email service management tool
- Work email cases
- Work cases to resolve customers technical issues
- File trouble tickets
- Respond to inbound emails
- Distribute No Reply email blast
- Resolved customer password issues
- Resolved customer login issue
- Investigated customer IOS device issues
- Completed iOS troubleshooting
- Complete Mac OS troubleshooting
- Completed repairs of IOS Devices Mac OS devices watch os devices
- Order repair parts
- Sell Apple care plus products
Freelancer
SSP Design
01.2013 - Current
- Assist small businesses with set up
- Assist with social media management
- Assist with copy writing task
- Assist with inventory management
- Assist with daily task
- Assist with product management
- Assist with e-commerce management
Insurance Specialist
Credit Acceptance Corp
01.2013 - 12.2013
- Process lock box payments, took inbound calls and made outbound calls to complete insurance task route
- Updated insurance claim information processed total loss claims filed for title changes to process repossession claims call repair facility to complete repair claims processed GAP claims on vehicles
Tier 2 Customer Service Representative
Verizon Wireless (Call Center Closed 6/29/12)
01.2002 - 06.2012
- Resolve Escalated Equipment Issues
- Resolved technical issues by performing comprehensive Tier I and II diagnostics.
- Research Device fail issues
- Research Network
- End User Support
- Expertly liaised with internal and external resources for resolving BlackBerry BIS issues.
- PC&Air card Trouble shooting
- File Network & Billing system Trouble Tickets
- Direct fulfil warranty Devices
- Resolve Get it Now & Application issues
- Taking escalated call loads
- Escalation call back
- Completed team meetings
- Desk drops of new policy & procedures going over monthly stats to assure representatives are successful
- Monitoring call handle time, rockwell codes to assure no call avoidance
- Took inbound calls in a high volume call center to make sure answer rate was accurate
- Made sure customer issues were resolved and that they had the right products that Fit their needs
- Processing phone orders and accessories orders, set up new phones
- Resolve internal and external customer issues
- Completed account updates
- Matching customer with the right device for their needs
- Provided floor Support to assure 1st call resolution
Medical Biller Medical receptionists
Dr Martin Tuma Vascular Surgeon
01.1998 - 12.2001
- Processed Medical office claims for a vascular surgeon office
- Look up correct Billing code
- Verified insurance card information
- Verified coverage
- Requested specialists referrals
- Submitted authorization for hospital admissions
- Submitted authorization for vascular surgery
- Submitted medical billing claims manually and electronically when available
- Status insurance payments
- Resubmitted rejected claims
- Handled petty cash
- Handled Booking keep task
- Set patient follow up appointment
- Set to room for patient visit
- Set up rooms for wound care and staple removals
Education
Some college - Health And Wellness
Macomb Community College
Warren, MIHigh School Diploma -
Redford High School
Detroit, MI06.1996
Skills
- Excellent attention to detail
- Highly reliable
- Very organized
- Fast learner
- Problem solver
- Claims Resolution
- Claim Analyzing
Certification
- Medical Assistant, Present
- Apple Certified Technician, Present
Personal Information
Authorized To Work: US
Timeline
Tier 2 Customer Service Claims Representative
Blue Cross And Blue Shield Of Michigan
09.2024 - Current
Provider Relations Representative
Blue Cross and Blue Shiel of Michigan
03.2023 - 09.2024
Email Response Technician
Apple inc.
08.2017 - 05.2022
Freelancer
SSP Design
01.2013 - Current
Insurance Specialist
Credit Acceptance Corp
01.2013 - 12.2013
Tier 2 Customer Service Representative
Verizon Wireless (Call Center Closed 6/29/12)
01.2002 - 06.2012
Medical Biller Medical receptionists
Dr Martin Tuma Vascular Surgeon
01.1998 - 12.2001
- Medical Assistant, Present
- Apple Certified Technician, Present
Some college - Health And Wellness
Macomb Community College
High School Diploma -
Redford High School
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