Summary
Overview
Work History
Education
Skills
Timeline
Generic

STEPHANIE Jack

Buckhannon,WV

Summary

Energetic customer service professional bringing solid background in Customer Service environments and exceptional attention to detail. Preserve and boost company standards with care, compassion and careful investigations of complaints and issues. Manage calls effectively to maximize productivity. Dependable, and seeking opportunity to expand skills and contribute to company success. Considered hardworking, ethical, and detail-oriented. Creative customer care professional dedicated to consistently surpassing service goals with unparalleled support for customer needs. Collaborative leader with dedication to partnering with coworkers to promote engaged, empowering work culture. Documented strengths in building and maintaining relationships in dynamic, fast-paced settings.

Overview

9
9
years of professional experience

Work History

Prior Authorization Representative

Cigna
11.2022 - Current
  • Verified eligibility and compliance with authorization requirements for service providers.
  • Fielded telephone inquiries on authorization details from plan members and medical staff.
  • Processed new medication requests for authorization.
  • Maintained patient confidentiality and safeguarded medical records to avoid information breaches.
  • Communicated pertinent information to client's prescribing provider to facilitate quality service.
  • Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
  • Triaged unscheduled and emergency authorizations, directing submissions to appropriate personnel for rapid response.
  • Responded to inquiries from healthcare providers regarding prior authorization requests.
  • Input all patient data regarding claims and prior authorizations into system accurately.
  • Developed and maintained productive working relationships with healthcare providers.
  • Top of training class, granted 10 hr shift bid
  • Worked with Manager, Nursing Staff and Sr Par's doing special assignments.
  • Attend daily UHA claims meetings
  • Recently named Subject Matter Expert from Supervisor for OnePA system and help guide those working in system
  • Been taught by Sr. Par's how to do Par2 duties , 3rd notifications and verbals.
  • Help to maintain service levels for plans and make sure department expectations are met daily, weekly and monthly.

Customer Care Team Lead

Elixir Solutions
11.2021 - 11.2022
  • Sought out every opportunity to improve customer experiences to delight customers and build trust
  • Returned every call or email before end of each day, maintaining both speed and professionalism
  • Achieved first call resolution for majority of customer contacts using expert knowledge of products, services, and internal systems
  • Resolved complex issues requiring extended investigations and support and diligently followed up on solutions
  • Resolved customer grievances consistently, collaborating with team members to achieve creative solutions
  • Updated records with all interactions and customers transactions
  • Mentored team members to apply quality customer service techniques to foster satisfaction
  • Maintained professionalism, positive attitude and confidentiality
  • Maintained and followed HIPAA guidelines at all times
  • Resolved issues from member, providers, pharmacy groups and employer groups
  • Documented all call information according to standard operating procedures
  • Entering date accurately and timely
  • Informed supervisors and managers on escalated issues, accomplishments, productivity of team members.
  • Maintained and managed customer files and databases.
  • Assisted call-in customers with questions and orders.

Customer Service Representative/ Customer Service Ancillary Team Lead

Elixir Solutions
05.2021 - 11.2021
  • Achieved customer satisfaction by addressing and providing swift resolution for escalated complaints
  • Mentored team members to apply quality customer service techniques to foster satisfaction
  • Resolved customer grievances consistently, collaborating with team members to achieve creative solutions
  • Effectively met inbound customer needs while maintaining strict performance targets
  • Updated records with all interactions and customers transactions
  • Completed inquiries and followed up withcustomers to share findings and offer solutions.

Customer Care RepresentativeContractor

Everstaff for Elixir Solutions
09.2020 - 05.2021
  • REFERENCES
  • Resolved issues based on thorough investigations of concerns
  • Maintained professionalism, positive attitude and confidentiality
  • Maintained and followed HIPAA guidelinesat all times
  • Assisted in/ Resolved issues from member, providers, pharmacy groups and employer groups
  • Researched required information using available resources
  • Utilized multiple company database programs for accessing member/plan information
  • Documented all call information according to standard operating procedures
  • Entering date accurately andtimely
  • Informed supervisors and managers on escalated issues, accomplishments, productivity of team members
  • Maintained detailed records covering customer requests and problems, and implemented resolutions andrelevant feedback
  • Sought out every opportunity to improve customer experiences by going beyond basics to delightcustomers and build trust
  • Achieved first call resolution for members, pharmacies and physicians
  • Resolved complex issues requiring extended investigations and support, diligently following up andcoordinating solutions
  • Referred unresolved customer grievances to designated departments for further investigation
  • Resolvedissues based on thorough investigations of concerns
  • Answered questions about deductibles, co-pay, coinsurance, Medication formulary, non-formulary formember, physicians and pharmacies
  • Resolved Pharmacy claim rejections in accordance with individual plan guidelines, authorizing overrideswhen allowed and/or initiate Prior Authorizations requests.

Supervisor/Certified Training Officer/ Quality Assurance and Quality, Improvement Analyst/ Tele

Upshur County E-911 Emergency Services
12.2014 - 06.2020
  • Effectively worked in the Customer Service industry within Emergency Services for over 6 years
  • Advanced to Supervisor position in less than 2 years
  • Completed Quality Assurance/Quality Improvement review on all calls
  • Excelled in an often stressful and busy environment
  • Answered phones and dispatched appropriate help or assistance to locations for multiple agenciesfollowing policy and procedures
  • Supervised employees and handled all administrative duties including but not limited to: reprimands,investigations, and the construct of agency policy and procedures.

Education

Bachelor of Science - Psychology

Fairmont State University
Fairmont, WV
06.2024

High School Diploma -

Buckhannon-Upshur High School
Buckhannon, WV
06.1993

Skills

  • Organizational Leadership
  • Documentation
  • Medical Terminology
  • Problem Resolution
  • Program Understanding
  • Customer Satisfaction
  • Authorizations
  • Records Maintenance
  • Effective Communication Skills
  • Data Entry
  • Professional Relationships

Timeline

Prior Authorization Representative

Cigna
11.2022 - Current

Customer Care Team Lead

Elixir Solutions
11.2021 - 11.2022

Customer Service Representative/ Customer Service Ancillary Team Lead

Elixir Solutions
05.2021 - 11.2021

Customer Care RepresentativeContractor

Everstaff for Elixir Solutions
09.2020 - 05.2021

Supervisor/Certified Training Officer/ Quality Assurance and Quality, Improvement Analyst/ Tele

Upshur County E-911 Emergency Services
12.2014 - 06.2020

Bachelor of Science - Psychology

Fairmont State University

High School Diploma -

Buckhannon-Upshur High School

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STEPHANIE Jack