Sylvia Wise
Customer Service Representative
Jacksonville,FL
Summary
Dedicated and results-driven professional with a proven track record of personal accountability and a passion for achieving excellence. Skilled in executing strategic initiatives and driving project success through effective collaboration and leadership. Committed to continuous improvement and fostering a positive team environment.
Overview
9
9
years of professional experience
4
4
years of post-secondary education
Work History
Customer Service Representative
CVS/Aetna
Jacksonville, FL
06.2023 - Current
- Examine medical records, procedure codes, diagnosis codes, and billing information to assess the appropriateness of a claim
- Apply appropriate medical necessity guidelines to assess claim validity
- Reviewed and analyzed submitted medical claims, collaborating directly with healthcare providers to resolve discrepancies or clarify any issues related to procedure codes, diagnosis codes, and billing information
Medical Transportation Coordinator
One Call
Jacksonville, FL
08.2020 - 06.2023
- Collaborate with external and internal customers in fast-paced environment to address requests via phone, email, and written communication
- Contact nurse and case managers to obtain authorization
- Take referrals from adjusters and case managers
- Navigate multiple software systems to document and provide information to patients
- Assess member’s documents to determine suitable mode of transportation and confirm service is covered
Senior Customer Service Specialist
Citi Bank
Jacksonville, FL
02.2016 - 10.2019
- Establish and maintain client portfolio through regular calls
- Provide solutions to customer concerns and questions, ensuring proper investigation and timely resolution
- Provide exceptional customer experiences by building rapport and ensuring positive, friendly interactions, all while aiming for one-call resolution
- Proficient in navigating various computer systems to conduct comprehensive account analysis, perform research, and manage monetary transactions
- Offer client information of their credit and debt, in attempt to resolve delinquency
- Comply with monthly efficiency goals in buckets
Education
Accredited Event Designer - undefined
The Institue of Wedding and event
High School Diploma -
Robert E. Lee Senior Highschool
Jacksonville, FL 09.2007 - 06.2011
Skills
- Strategic Planning
- Excellent written and verbal communication skills
- Troubleshooting
- Critical thinking
- Attention to detail
- Complaint resolution
- Product knowledge
Timeline
Customer Service Representative
CVS/Aetna
06.2023 - Current
Medical Transportation Coordinator
One Call
08.2020 - 06.2023
Senior Customer Service Specialist
Citi Bank
02.2016 - 10.2019
High School Diploma -
Robert E. Lee Senior Highschool
09.2007 - 06.2011
Accredited Event Designer - undefined
The Institue of Wedding and event
Similar Profiles
Jody Nelson MDJody Nelson MD
Medical Director, SWAT Team at CVS/AetnaMedical Director, SWAT Team at CVS/Aetna
KIMBERLY SPEARSKIMBERLY SPEARS
Quality HEDIS Abstractor Lll (contract) at CVS/AetnaQuality HEDIS Abstractor Lll (contract) at CVS/Aetna
David StineDavid Stine
Quality Provider Liaison at CVS/AetnaQuality Provider Liaison at CVS/Aetna