Syreeta Carter

• Handled customer inquiries and suggestions courteously and professionally.
• Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
• Answered constant flow of customer calls with minimal wait times.
• Answered customer telephone calls promptly to avoid on-hold wait times.
• Offered advice and assistance to customers, paying attention to special needs or wants.
• Responded to customer requests for products, services, and company information.
• Clarified customer issues and determined root cause of problems to resolve product or service complaints.
• Delivered exceptional customer service to every customer by leveraging extensive knowledge of products and services and creating welcoming, positive experiences.
• Met customer call guidelines for service levels, handle time and productivity.
• Managed timely and effective replacement of damaged or missing products.
• Promoted available products and services to customers during service, account management, and order calls.
• Promptly responded to inquiries and requests from prospective customers.

• Reviewed insurance and claims documents to verify required information and secure any missing data for settlements.
• Followed up with customers on unresolved issues.
• Understood requirements for disputes, gathered evidence to support claims and prepared customer cases to handle appeals.
• Monitored compliance with regulations and industry best practices to promote fair and proper treatment for insured customers.
• Responded to inquiries by answering questions, providing information and directing customers to appropriate resources.

• Process claims and adjustments identified in service requests from Customer Service.
• Review and research incoming healthcare claims from providers (doctors, clinics, etc.) and verify the data/information necessary for processing (e.g. pricing, prior authorizations, applicable benefits).
• Identify, analyze and resolve common, complex, and escalated operational issues impacting professional, hospital, ambulatory surgical center, and ancillary providers or the members and groups that they serve.
• Identify and document global and/or systemic problems, gaps, or inconsistencies in workflows, and/or processes based on collected information related to provider issues and provides recommendations for updates, alternatives and/or solutions.
• Provide analysis and feedback for technologies, trends, best practices, and service offerings to incorporate them into overall stakeholder business solutions.
• Provide coaching and feedback to customer service and claims departments regarding claims and claims errors.
• Educate and encourage providers on use of alternative delivery channels including self-service, Blue E, web, etc. Educate providers on acceptable BCBSNC practices and policies.
• Provide cross functional support between the provider and various areas within the Plan including local, state and federal government entities across all lines of business
• Effectively manage inventory to meet departmental goals and Service Level Agreements (SLA)
• Handle special projects or requests from Provider Service Consultants and Coordinators as necessary.
• Manage team mailbox and escalation phone line to address issues received from the Provider Service Consultants and Coordinators, Network Management, and the Leadership Team.

• Support and be committed to the mission, vision and values of the company by delivering seamless, energetic and innovative service solutions to increase stakeholder satisfaction and retain customers.

• Utilize probing and creative problem solving methods to resolve foundational customer inquiries on first contact. Document corrective measures and provide instructions as needed to internal business areas to ensure prompt resolution and response to customer inquiries.

• Identify and obtain information and records from customers, members, providers and/or employer groups to correct/update information, claims and membership records when necessary.

• Recognize patterns of inconsistent and/or inaccurate claims filing practices among customers and providers, educate customers and providers on acceptable BCBSNC practices and policies.

• Perform phone/email outreach to BCBSNC vendors and business partners to resolve service issues.

• Identify, understand and anticipate customers’ unexpressed needs and concerns in a caring manner.

• Work collaboratively with Sales, Healthcare and Network Management partners to further optimize customer, employer group and provider relations by identifying opportunities to promote stakeholder programs. Promote programs, making sound decisions to apply the most appropriate “stakeholder centric” course of action to respond to needs.

• Educate and encourage customers on use of alternative delivery channels including self service, web, etc.

• Identify and communicate process, product or systems improvement opportunities to improve the overall stakeholder experience.

• Interface with local, state and federal governmental entities and plan participants regarding BCBSNC products, services and policies.