Shyandrea Wilkins
Seagoville,TX
Summary
Adaptable professional with 10 years of work experience and proven knowledge of leadership, problem-solving, and prioritization. Aiming to leverage my abilities to successfully fill the customer service role at your company.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Complex Customer Care Rep SR
UnitedHealthcare/ Optum
09.2022 - 12.2024
- Address billing issues regarding claims & do real time outreach calls to providers or other insurance carriers
- Responsible for providing high quality members experience as reflected, and post contract surveys and member feedback
- Serve as an ongoing, point of contact for members, primarily via the phone channel may also use (email ,chat , & text)delivering compassionate support to members, creating a memorable, positive experience
- Identified and resolved patient billing and payment issues.
- Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable.
- Ensured timely submission of claims to various insurance carriers, resulting in prompt payment for services rendered.
- Enhanced revenue collection through diligent follow-up on unpaid claims and denials with insurance companies.
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
- Supported pharmacy benefits and mail order services.
- Posted and adjusted payments from insurance companies.
- Skilled in utilizing EMR systems.
DISABILITY SPECIALIST
Accenture
12.2021 - 09.2022
- Handle STD & LTD intake claimsMake claim / customer eligibility determinations and manage on-going claims for an assigned caseload of short-term disability claims, through capturing medical information, applying appropriate contractual provisions, following legal guidelines, and leveraging expert resourcesAbility to handle potentially high levels of call volume from customers and clients
- Respond to various written and telephone inquiries, including eligibility, approval/denial determinations, status and continuation or closure of benefitsCommunicate with claimants, employers, and various medical professionals to gather information regarding the application for, payment of, and ongoing management of short-term disability benefits.Applied mobility assistance knowledge to safely ambulate patients in different spaces involving varying elevations and obstacles.
BENEFIT ADVISOR
KCI
08.2020 - 12.2021
- Retrieving medical record Responsible for contacting providers for update on patient account Processed insurance claim ICD 9 & ICD 10 Code & CPT Handling collections on past-due accounts A/R medical contact insurance company for prior authorization or payment for services
- Evaluated and maintained benefit plans to ensure compliance with applicable laws and regulations.
- Managed employee benefit programs, including health, dental and vision plans, retirement plans and life insurance
- Guided employees through the enrollment process for all benefit programs.
- Assisted employees regarding benefits claim issues and plan changes.
- Analyzed employee benefit trends and recommended changes to enhance benefit offerings.
- Collaborated with other departments, customers and insurance companies to resolve claims in an efficient and timely manner
- Conducted timely reviews of claims to ensure accuracy and completeness of documentation.
- Explained partial and full denials for items not covered under policies.
BENEFITS SPECIALIST
WageWorks
10.2019 - 08.2020
- Resolvedcustomers' servicecomplaints byhandling escalated
- Managed employee benefit programs, including health, dental and vision plans, retirement plans and life insurance
- Evaluated and maintained benefit plans to ensure compliance with applicable laws and regulations.
- Guided employees through the enrollment process for all benefit programs.
- Responded to benefit inquiries from employees on plan provisions, benefits enrollments and status changes.
- Conducted research and evaluation on benefits and industry trends, providing value-added analysis and summary.
- Used online benefits checklist process to determine eligibility to various entitlement programs.
- Understood customer requirements and tailored insurance plans to fit needs.
- Calculated premiums and established payment method.
- Called on policyholders to deliver and explain policy, to analyze insurance program and suggest additions and changes and to change beneficiaries
- Detected and evaluated potential fraudulent situations, reporting to leadership for investigation.
- Conducted timely reviews of claims to ensure accuracy and completeness of documentation.
- Explained partial and full denials for items not covered under policies.
- Collaborated with other departments, customers and insurance companies to resolve claims in an efficient and timely manner.
HEALTH UNIT COORDINATOR
09.2018 - 09.2019
- ResponsibleforcompletingenrollmentCompletedpre-authorizationforcustomersdaily Dealt with members who had
- Medicare & other health insurance Processed claims and reimbursement, Set up new dental professional account
- Place orders for dental professionals New product information Inbound calls Dental care & Pro shop questions or assists with helping to get account unlocked Process CC payments
- Demonstrated ability to manage multiple tasks while remaining adaptable and flexible.
- Worked with coworkers to complete tasks.
- Skilled in using various software applications and programs including Microsoft Office and Adobe Creative Suite.
- Responded quickly to meet customer needs and resolve problems.
- Committed to delivering excellent customer service while working in a fast-paced environment.
REPRESENTATIVE
Maximus
06.2015 - 06.2017
- Resolved customers' service complaints byhandling escalated calls Responsible for completing welcome calls for newmembers enrolling in Parkland Health Plan Processed insurance claim Dealt with members who had Parkland
- Health Plan& Other Health Insurance ICD 9 & ICD 10 Code & CPT Handling collections on past-due accountsMaximus - Customer Service and Health Care
- Conferred with customers through Outbound callsto discuss authorizations Resolved customers' service complaints byhandling escalated calls Responsible for completing welcome calls for newmembers enrolling in
- Health Net Veteran's Choice Program Completed pre-authorization for customers daily Dealt with members who had VCP & OtherHealth Insurance Processed authorizations set appointments
- Prepared patient charts for patient transfers by copying and organizing required documents according to specific criteria
- Conducted in-person greetings, welcoming and orientating newly admitted and transferred patients.
- Communicated with patients, families and health care team members regarding patient care.
- Scheduled and documented future appointments upon patient release.
- Transcribed doctor orders using medical terminology and abbreviations.
- Answered phone and call lights prompty, forwarding calls or information to appropriate staff.
- Filed laboratory results, x-ray reports and other documents in patient records upon receipt.
Customer Service
Connextions
06.2014 - 06.2015
- Conferred with customers through inbound calls todiscuss new enrollment information Resolved customers' service complaints byhandling escalated calls Responsible for completing welcome calls for newmembers enrolling in CVS Caremark and Well Care Mail order Completed pre-authorization for customers daily Dealt with members who had Medicare Processed claims and reimbursement request bysending the designated form to pharmacies
- Responded to customer inquiries via telephone, email, and in person.
- Educated customers about brand to initiate excitement about company's mission and values.
- Set up and updated customer accounts with interactions, payments and personal information.
- Utilized knowledge of products and services to resolve customer issues efficiently and effectively.
- Maintained logs and documentation to detail key information regarding incoming and outgoing calls.
SALES ASSOCIATE
Sears Holdings
10.2012 - 06.2015
- Greeted and engaged customers to determine their wantsor needs while also providing excellent customer service
- Recommend, selected, and helped locate orobtain merchandise based on customer needs Compute sales prices, total purchases and receiveand process cash or credit payment Answered questions regarding the store andits merchandise Maintained knowledge of current sales andpromotions, policies regarding payment and exchanges,and security practices Place special orders or call other stores to find desired items
- Greeted customers warmly and offered assistance.
- Promoted benefits of store credit cards or customer loyalty programs to encourage repeat business.
- Opened and closed cash registers, balanced cash drawers, and made deposits.
- Generated sales reports and tracked customer data to ensure sales goals were met.
- Tagged new merchandise for sale and updated signs.
- Assisted customers with product selection to ensure customer satisfaction.
Education
Lancaster High School
Skills
- Medical Coding Proficient With Computer Skills Medical Terminology Insurance Verification
- Documentation Review CPT Coding ICD-10 ICD-9 Medical Billing CSR Customer Support
- Customer Care Customer Service Call Center Word (7 Years) PowerPoint (7 Years)
- Microsoft Word (7 Years) Excel (7 Years)
Certification
2709732
Contact
Seagoville, TX 75159
Timeline
Complex Customer Care Rep SR
UnitedHealthcare/ Optum
09.2022 - 12.2024
DISABILITY SPECIALIST
Accenture
12.2021 - 09.2022
BENEFIT ADVISOR
KCI
08.2020 - 12.2021
BENEFITS SPECIALIST
WageWorks
10.2019 - 08.2020
HEALTH UNIT COORDINATOR
09.2018 - 09.2019
REPRESENTATIVE
Maximus
06.2015 - 06.2017
Customer Service
Connextions
06.2014 - 06.2015
SALES ASSOCIATE
Sears Holdings
10.2012 - 06.2015
Lancaster High School
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