Suzette Bartylla
Mishawaka,IN
Summary
Poised professional with many years of experience in mediating disputes between parties to deliver peaceful resolutions. Independent-thinker talented in devising solutions specific to each conflict and situation. Active listener with attention on maintaining communication throughout case assessment and resolution.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Resolution Coordinator
Promoted from DSN to JandB Medical
Wixom/ 100% Remote Work From Home, MI
12.2022 - 03.2024
- Researched and analyzed customer complaints to identify trends, potential root causes, and opportunities for improvement.
- Performed detailed data entry into internal tracking systems to ensure accurate resolution of customer issues.
- Drafted written responses to customer inquiries in a timely manner while following established guidelines.
- Collaborated with cross-functional teams to develop strategies that addressed customer concerns and improved operational efficiency.
- Monitored incoming customer service emails and phone calls, responding promptly and professionally to inquiries.
- Coordinated the resolution process between customers, management team, field staff, vendors, suppliers.
- Developed and implemented procedures for resolving complex customer disputes in accordance with company policies.
- Facilitated internal meetings to review escalated cases; identified areas of improvement and provided recommendations.
- Maintained up-to-date records of all interactions with customers using appropriate documentation techniques.
- Provided feedback on customer experience surveys by analyzing survey results for further action or improvement initiatives.
- Ensured adherence to key performance indicators related to resolution times and quality standards across all channels of communication.
- Analyzed reports from various departments such as sales, finance, marketing, to assess overall performance against goals set out by the organization.
- Assisted in developing training materials for new employees on how best to resolve customer complaints efficiently.
- Conducted regular follow-up calls with customers after resolutions were completed in order to ensure satisfaction.
- Identified any potential risks associated with resolving customer issues before making final decisions.
- Communicated effectively with other departments regarding progress made towards resolving customer issues.
- Reviewed existing processes for resolving customer issues and proposed changes where necessary.
- Utilized problem solving skills when dealing with challenging situations or difficult customers.
- Provided insights into the effectiveness of current processes used for addressing complaints from customers.
- Facilitated communication and collaboration among disputants using mediation methods.
- Specialized in negotiation and resolution of environmental conflicts involving natural resource allocation and regional development planning.
- Conducted studies of appeals procedures to confirm adherence to legal requirements while facilitating disposition of cases.
- Reviewed and resolved online complaints, BBB, bad reviews, etc.
- ICD-10 and the conversion from ICD-9 medical coding.
- Medical terminology.
- Insurance billing with an Indiana insurance license.
- Medicaid Specialist training and certified.
- Experience with private insurance, Medicaid, and Medicare.
- Experience with data entry and accounting.
- Experience with human resources.
- Experience with incoming call que, answering, transferring, etc.
RX Team Leader/Senior QA Analyst
DSN dba JandB Medical
Mishawaka / Remote Work From Home, Indiana
10.2019 - 03.2024
- Coordinated team activities and delegated tasks to ensure efficient completion of projects.
- Developed strategies for problem solving and conflict resolution among team members.
- Responsible for calling doctors' offices, members, or insurance companies.
- Incoming call queue.
- Reading and processing any prescriptions from doctors.
- Any communication to the client regarding the prescription from the doctor.
- Knowledge of ICD-10 medical coding, medical terminology, etc.
- Processing of the prescription to receiving the product.
- Mass processing of all prescriptions received by the company.
- Leadership skills for the team and company leadership.
- Reviewing and analyzing calls for company for quality assurance. One-on-one meetings with employees regarding the QA/compliance results.
Auction Assistant/ Part Time for Season
Kaser Auctions
South Bend, IN
07.2013 - 12.2023
- Provided assistance to the auctioneer during bidding processes.
- Assisted in collecting payments from successful bidders and issuing receipts.
- Organized auctions by setting up tables and chairs, arranging items for sale, and displaying materials.
- Advertised upcoming auctions through various media outlets such as newspapers, radio, television, and online platforms.
- Maintained accurate records of all transactions related to the auction process.
- Processed payments received from successful bidders via cash or credit card.
- Arranged merchandise in display cases according to type or size for maximum effect.
- Calculated sales taxes on purchases made at auctions and collected them from customers as required by law.
- Managed customer inquiries about products being sold at the auction house.
- Monitored bids placed during an auction event using a computer system or other technology-based tools.
- Ensured safety protocols were followed throughout the entire duration of an auction event.
- Collaborated with other staff members in order to maintain efficient operations within the department.
- Attended training sessions regularly in order to stay updated on new developments within the industry.
- Performed administrative tasks such as filing paperwork, preparing reports, and responding to emails related to auctions.
- Provided excellent customer service when interacting with clients both before and after an auction event.
- Made copies, filed sales receipts and orders, sent faxes, wrote sales contracts and executed other general office organization duties.
- Greeted and assisted customers to foster positive experiences.
- Operated register, handled cash and processed credit card transactions.
- Used excellent verbal skills to engage customers in conversation and effectively determine needs and requirements.
- Recognized security risks to properly handle situations.
- Accounting for entire sale. Registration, bids, and payments of all types.
Medicaid Eligibility Specialist
Indiana FSSA
South Bend, IN
05.2016 - 10.2019
- Greeted customers and provided exceptional customer service.
- Assisted customers with product selection, sizing and styling.
- Provided accurate information about products, prices and services.
- Processed transactions using a point-of-sale system.
- Maintained up-to-date knowledge of store merchandise and policies.
- Conducted initial eligibility screenings for Medicaid applicants.
- Reviewed applications and supporting documents to determine applicant's eligibility for Medicaid benefits.
- Compiled and documented information regarding applicant's income, assets, insurance coverage and other relevant data.
- Verified accuracy of applicant's financial information against third-party sources such as employers, banks or government agencies.
- Prepared reports summarizing findings of eligibility reviews.
- Processed requests for changes in existing Medicaid cases.
- Assisted individuals with the completion of complex paperwork related to their application process.
- Researched discrepancies between submitted forms and available records to ensure compliance with regulations.
- Maintained up-to-date knowledge of state and federal regulations pertaining to Medicaid eligibility.
- Investigated complaints regarding eligibility determinations or denials.
- Responded promptly to inquiries from applicants, providers and other stakeholders concerning Medicaid services.
- Attended training sessions, seminars and workshops related to Medicaid programs.
- Advised clients on how best to utilize available resources in order to meet their needs.
- Updated case management systems with current information regarding client status.
- Established relationships with community organizations that provide assistance in obtaining health care services for low-income families.
- Explained eligibility details and affordability options to patients with kindness and respect.
- Conversed with people from different cultures daily, providing high level of respect and patience with each interaction.
- Maintained positive working relationship with fellow staff and management.
- Informed applicants of other agencies providing useful or related assistance.
- Conducted interviews with applicants, explaining benefits process, and which programs were available.
- Granted, modified, denied, or terminated assistance based on key information and eligibility determination.
- Performed careful reviews of applicant data to ascertain compliance with eligibility criteria for economic assistance.
- Proofread documents carefully to check accuracy and completeness of all paperwork.
- Answered questions and responded to inquiries to deliver high level of service to patients.
- Maintained confidential patient documentation to prevent data compromise and comply with HIPAA regulations.
Education
High School Diploma -
Center Grove High School
Greenwood, IN01-1992
Some College (No Degree) - General
IUSB
South Bend, INInsurance Agent Licensing
PTI
Indianapolis, INSkills
- De-Escalation Techniques
- Written Communication
- Continuous Improvement
- Adaptability
- Professionalism
- Team Collaboration
- Teamwork and Collaboration
- Self Motivation
- Legal knowledge
- Excellent Communication
- Analytical Thinking
- Decision-Making
- Effective Communication
- Time management abilities
- Interpersonal Communication
- Multitasking
- Attention to Detail
- Document Preparation
- Professional Demeanor
- Organizational Skills
- Analytical Skills
- Problem-solving aptitude
- Reliability
- Active Listening
Certification
- Indiana Insurance License
- Medicaid Specialist Certification
Affiliations
- Fast pitch softball
- Fishing
- Water activities
- clubs
- Interest in sports
- Love of nature
Accomplishments
- Top Insurance CSR Team for state
- Top Resolution Specialist for company
References
References available upon request.
Timeline
Resolution Coordinator
Promoted from DSN to JandB Medical
12.2022 - 03.2024
RX Team Leader/Senior QA Analyst
DSN dba JandB Medical
10.2019 - 03.2024
Medicaid Eligibility Specialist
Indiana FSSA
05.2016 - 10.2019
Auction Assistant/ Part Time for Season
Kaser Auctions
07.2013 - 12.2023
- Indiana Insurance License
- Medicaid Specialist Certification
High School Diploma -
Center Grove High School
Some College (No Degree) - General
IUSB
Insurance Agent Licensing
PTI
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