Tanyel Allen

•Conducted intensive interviews to determine eligibility for financial, childcare, medical, and/or food assistance benefits •Analyzed oral and written information to determine accurate benefits and continued program eligibility

•Assessed immediate needs in emergent situations

•Obtained and reviewed necessary data, documentation, and verification for each program of assistance as it relates to the recipients specific circumstances

•Explained program requirements and services available, refer clients to both mandatory and optional services and to other agencies as required

•Read and interpret Washington Administrative Code and procedure manuals

•Assisted customers with the process of applying for Apple Healthcare by entering information into the Health Plan Finder system on behalf of the clients

•Detected discrepancies and clarified data through telephone inquiries, correspondence and, interviews; recognize and recalculate incorrect payments of grants, food benefits and medical assistance, and establish overpayments

•Worked within time frames and deadlines which are dictated by program requirements

•Attended and completed required training courses as mandated by the agency

• Audited Configuration of all standard benefit plans for Medical, Dental, RX, and Vision. Utilized Facets, BQT Admin, BSR/GSR's, Benefit Booklets, Quote Language, and other tools to audit. Researched and Identified analyzes root cause, and provided individualized feedback based on errors identified. Coached other team members as appropriate to improve performance, quality, efficiency and consistency. Maintained in-depth working knowledge of procedural changes, audit techniques, plans, and automated systems. Managed assigned workload including identifying and resolving issues.
• Maintained a strong understanding of industry regulations and ensured company compliance through regular audits.
• Improved overall customer satisfaction by ensuring that all products met established quality standards.
• Ensured timely completion of all assigned audits while maintaining a high level of detail and accuracy.
• Reviewed work instructions and production strategies to verify compliance with established standards.
• Identified issues of non-compliance and elevated reports to senior personnel.

• Worked as an Acting Account Services Rep 1 serving as a liaison between marketing department, clients, members, account managers, customer service and producers providing timely, accurate, courteous, and concise responses to escalated inquiries in person, by telephone, or by correspondence. Presented a professional image to our members, clients, producers, and co-workers. Provide back up to the Technical Support Specialist, and complete special projects and perform other duties as they are assigned. Interact with all other departments within PBC to answer questions, resolve problems and ensure that plan and department requirements are met. Submit procedure updates and CSI updates to ensure all information is update to date and accurate. Participated in department staff meetings, and updating staff on new business and significant changes and or modifications such as benefits, and contract changes.
• Delivered prompt service to prioritize customer needs.
• Exhibited high energy and professionalism when dealing with clients and staff.
• Met customer call guidelines for service levels, handle time and productivity.
• Promptly responded to inquiries and requests from prospective customers.

• Handled telephone inquiries regarding benefits, claim adjudication, eligibility issues within the proscribed criteria for time and consistency, and professionalism. Key inquiries and responses onto current system. Follow up on previously handled inquiries. Set up reprocessing of claims, claims history review, resolve eligibility issues, research system errors. Respond to written claims tracers. Notify providers telephonically or by writing of claims payments/denials. Work Pend Burn Down, Worked as a 5S Ambassador, Research and Resolve additional request handed down by supervisor.
• Demonstrated excellent multitasking abilities by managing multiple concurrent tasks while ensuring timely completion.
• Engaged clients in person and over phone to answer questions and address complaints.
• Enhanced customer satisfaction by promptly addressing and resolving complex inquiries and complaints.
• Resolved customer service issues using company processes and policies and provided updates to customers.

• Resolved customer complaints, provided customer service, handled billing, account activation's and account cancellations Assisted the supervisor by maintaining attendance and compliance records Reviewed files, records, and other documents to obtain information in response to requests
• Handled customer inquiries and suggestions courteously and professionally.
• Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
• Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
• Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
• Answered customer telephone calls promptly to avoid on-hold wait times.
• Updated account information to maintain customer records.