Shikelia
Henderson,NC
Summary
Versatile Customer Service Specialist highly effective at conflict resolution and persuasive communication. Knowledgeable about quality assurance and training. Reliable and driven, with strong time management and prioritization abilities. Hardworking and reliable with an excellent attention to detail.
Overview
9
9
years of professional experience
Work History
Patient Service Associate
Duke Health
07.2024 - 04.2025
Pharmacy Help Desk Representative
Continuum
10.2021 - 06.2022
- Received inbound calls from other representatives needing assistance with claims.
- Researched denied claims, conducted coding reviews of medical records, and supported documentation against denied claims.
- Conducted insurance verification to understand if a patient’s prescribed therapy is eligible for coverage.
- Responded to inquiries via phone, email, and chat.
- Resubmitted claims with accurate coding.
- Verified members benefits and eligibility.
- Worked with commercial insurance as well Medicaid and Medicare.
- Utilized multiple computer systems and monitors.
Customer Service Representative
Pomeroy
01.2020 - 10.2021
- Made 40-50 outbound calls to providers negotiating settlements and claims.
- Responded to escalated calls from customer service regarding prescriptions, medical claims, payments, and eligibility issues.
- Corresponded to patient and physician’s questions regarding EOB’s, patient balances, co-pays, deductibles, write-offs, etc.
- Resolved patient complaints and explained why certain services aren’t covered.
- Reviewed EOBs (explanation of benefits) from insurance companies.
- Processed claims and performed completion of claims to payers.
- Conducted research of claims systems to identify adjudication issues.
Customer Service Representative/Subject Matter Expert
Continuum
11.2017 - 12.2019
- Assisted Aetna Insurance members with insurance policies and current coverage.
- Explained copays, deductibles, coinsurance, and out of pocket maximum to members.
- Called other insurance companies and healthcare physicians on behalf of members per the company.
- Explained different stages of insurance plans to members.
- Adhered to HIPAA policies and protocols, becoming HIPAA certified.
- Navigated through multiple computer applications with speed and accuracy.
- Responded to 75-100 inbound calls a day in a high call volume environment.
- Ensured productivity met or exceeded service and quality standards.
Customer Service Representative
Samsung Electronics
11.2015 - 09.2017
- Navigated through multiple computer applications with speed and accuracy.
- Accepted and implemented coaching/feedback to achieve individual and team performance goals.
- Maintained expectations regarding call quality and resolution time.
- Handled customers questions, complaints, and billing inquiries with the highest degree of courtesy and professionalism.
- Offered alternative solutions where appropriate with the objective of retaining customer ‘s business.
- Handled customer interactions in connection with activation of accounts on a computer terminal.
- Answered customer requests or inquiries concerning products, billing, equipment, and claims.
Education
High School Diploma -
Western Vance High School
01.2014
Skills
- Strong Work Ethics
- Microsoft Office Suite
- Insurance Verification
- HIPAA Certified
Timeline
Patient Service Associate
Duke Health
07.2024 - 04.2025
Pharmacy Help Desk Representative
Continuum
10.2021 - 06.2022
Customer Service Representative
Pomeroy
01.2020 - 10.2021
Customer Service Representative/Subject Matter Expert
Continuum
11.2017 - 12.2019
Customer Service Representative
Samsung Electronics
11.2015 - 09.2017
High School Diploma -
Western Vance High School