TONI JAMES
Kansas City,MO
Summary
Results-driven customer service representative skilled in managing high call volumes and resolving inquiries efficiently. Collaborative team player recognized for developing effective communication strategies and driving improvements in customer service processes. Adept at maintaining professionalism in challenging situations and meeting performance benchmarks.
Overview
30
30
years of professional experience
Work History
Customer Service Representative
Integrated Resources Inc
11.2025 - 02.2026
- Received phone calls from members, providers, POA's and others, about their medications, prescriptions and coverage of insurance for CVS Health call center. Managed high-volume inbound calls for customer inquiries
- Resolved customer inquiries and concerns, providing quality service that met performance benchmarks.
- Maintained a positive demeanor while addressing challenging customer situations.
- Provided product information and support to enhance customer understanding.
- Updated customer accounts, addresses and contact information within call management databases.
- Identified opportunities to improve policies and procedures related to customer service operations
- Collaborated with team members to develop effective communication strategies.
Provider Data Management Representative
Government Employees Healthcare Association
Lee's Summit, Missouri
09.2010 - 12.2024
- Engaged with providers to obtain essential details for record accuracy, facilitating updates and setup of new locations.
- Assisted with completing providers' additions, changes, and terminations of office locations and hospitals.
- Utilizes the NPPES NPI Registry to verify a provider NPI number.
- Updates of providers' contact information into Facets.
- Answer questions about claims or entries. Utilized Salesforce to manage client relationships and track interactions. Sent letters to physicians for missing information or unclear instructions on a claim, if I can't reach by phone.
- Implemented protocols ensuring compliance with HIPAA and PHI regulations.
- Complied with regulations set forth by the Office of Personnel Management. of the OPM.
Data Entry Processor and clerk
DST Systems
05.1996 - 05.2010
- Assisted training new staff on data entry procedures and tools.
- Detected, corrected, and reported data entry errors to maintain data integrity.
- Reviewed and verified data for discrepancies before entry.
- Operated proof machine to encode checks and managed mail distribution.
- Operated machinery in compliance with established safety protocols.
- Worked successfully with a diverse group of coworkers to accomplish goals and address issues related to our products and services.
Education
No degree -
Florissant Valley Community College
01-1990
Diploma -
Mc Cluer High School
Florissant, MO01-1989
Skills
- Claim processing
- Facets Application
- Customer account updates
- Client relationship management
- Data entry
- HIPAA compliance PHI
- Timely task completion
- Attention to detail
- Problem-solving
- Critical thinking
- Time management
- Account management
Accomplishments
- Top quality and production standards above 99% -awards
Timeline
Customer Service Representative
Integrated Resources Inc
11.2025 - 02.2026
Provider Data Management Representative
Government Employees Healthcare Association
09.2010 - 12.2024
Data Entry Processor and clerk
DST Systems
05.1996 - 05.2010
No degree -
Florissant Valley Community College
Diploma -
Mc Cluer High School