Talecia Thompson
Monroe,LA
Summary
Hardworking Customer Service Representative with five years of experience with the development and enforcement of policies and procedures in a company. Looking for a manager position in a dynamic organization where my skills will be fully utilized. Proficient in a range of computer applications. Well-developed communication and customer service skills. Proven ability to efficiently plan and manage multiple assignments to meet tight deadlines.
Overview
7
7
years of professional experience
Work History
CSR Benefit Advocate| Senior CSR Health Advocate
UnitedHealth Group
12.2022 - Current
- Respond to and resolve, on the first call, customer service inquires and issues by identifying the topic and type of assistance the caller needs such as benefits, eligibility and claims, and correspondence
- Help guide and educate customers about the fundamentals and benefits of consumer-driven health care topics to select the best benefit plan options, maximize the value of their health plan benefits and choose a quality care provider
- Contact doctor’s offices, pharmacies, and medical groups on behalf of the customer to assist with questions, schedule appointments, and close gaps in care
- Make outreaches where necessary to with internal specialists for assistance
- Assist customers in navigating myuhc.com and other UnitedHealth Group websites and encourage and reassure them to become self-sufficient
- Assists in maintaining a clean, organized and efficient work area, including maintaining supplies necessary to perform job duties
- Provide single point of contact for the member for highly designated or dedicated UHC national or key account insurance plans
- Respond to and own consumer inquiries and issues by identifying the topic and type of assistance the caller needs such as benefits, eligibility, claims, financial spending accounts, correspondence, OptumRx Pharmacy, Optum Behavioral Health and self-service options
- Own problem through to resolution on behalf of the member in real time or through comprehensive and timely follow-up with the member
- Educate members about the fundamentals and benefits of consumer-driven health care topics to include managing their health and well-being so they can select the best benefit plan options and maximize the value of their health plan benefits
- Advocate and intervene with care providers (doctor’s offices) on behalf of the member to assist with appointment scheduling, billing concerns, and coverage determinations
- Assist members in navigating myuhc.com and other UnitedHealth Group websites or applications utilizing remote desktop system capabilities.
Customer Service Representative/ Quality Control Analyst
Staffing Solutions
01.2020 - 12.2022
- Evaluated account and service histories to identify trends, using data to mitigate future issues
- Offered advice and assistance to customers, paying attention to special needs or wants
- Answered constant flow of customer calls with up to 50 calls in queue per minute
- Monitor all operations that affect quality
- Supervise and guide inspectors, technicians and other staff
- Educated customers about billing, payment processing and support policies and procedures
- Resolved billing and claims issues over phone with customers daily
- Keep records of quality reports, statistical reviews and relevant documentation
- Facilitate proactive solutions by collecting and analyzing quality data
- Ensure all legal standards are met
- Respond to inquiries regarding healthcare benefits from providers, brokers, employers and other customers
- Follow-up on caller inquiries that were not immediately resolved
- Provide assistance with claim lookups
- May perform duplicate coverage inquires
- Resolve conflict as the first point of escalation for customers or route to other staff who can resolve
- Accurately record information in the operating system to reflect all activity/interaction with member accounts and follow up
- Assessed caller accounts to determine healthcare benefits, identify service needs and resolve issues
- Used company troubleshooting resolution tree to evaluate technical problems while leveraging personal expertise to find appropriate solutions.
Account Resolution Specialist
Cyracom International Inc.
09.2018 - 10.2020
- Provides on the job training as needed and provides source of knowledge for staff inquiries
- Demonstrates a strong understanding of payer benefits requirements, on-line claims status, submission, billing, cash application, and reconciliation procedures
- Approve or deny requested adjustments and refunds within role thresholds
- Adapt to process and procedure evaluations and improvements, support continuous change, and willingly manage special projects in addition to normal workload and other duties as assigned
- Responsible for professional and effective written and verbal communication with both internal and external customers in order to resolve outstanding for account resolution while maintaining account integrity and compliance with payer and/or government regulations
- Appropriately documents patient accounting host system or other systems utilized by Patient Financial Services in accordance with policy and procedures
- Provides continuous updates and information to Leadership Team regarding errors, issues, and trends related to activities affecting productivity, reimbursement, payment delays, and/or patient experience
- Functions effectively within a team and participates and contributes constructively to produce results in a cooperative effort
- Continually seeks to understand and act upon customer needs, concerns, and priorities
- Meets customer expectations and requirements, and gains customer trust and respect
- Demonstrates expertise in role requirements as outlined in job description for specific area of responsibility.
Education
High School Diploma -
West Monroe High School
05.2018
Associate of Applied Science - Licensed Practical Nursing
South Arkansas College
El Dorado, AR12-2025
Skills
- Healthcare Benefits
- Claim Billing
- Documentation
- Email & Fax
- Process invoices
- Legal Documentation
- Payroll & Payroll Processing
- Policies
- Sales
- Proficient Typing
- Case Management
- COMPUTER
- Microsoft Office Suite
- Excel
- Word
- Access
- Outlook
- PowerPoint
Education and Training
true
Timeline
CSR Benefit Advocate| Senior CSR Health Advocate
UnitedHealth Group
12.2022 - Current
Customer Service Representative/ Quality Control Analyst
Staffing Solutions
01.2020 - 12.2022
Account Resolution Specialist
Cyracom International Inc.
09.2018 - 10.2020
High School Diploma -
West Monroe High School
Associate of Applied Science - Licensed Practical Nursing
South Arkansas College
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