Victoria Harris
Hephzibah,USA
Summary
Customer care and fraud investigation expert with over 10 years of experience across healthcare, education, and financial services. Demonstrated success in resolving complex issues and preventing escalations while enhancing member experiences. Proficient in fraud detection, data analysis, and managing client relationships.
Overview
15
15
years of professional experience
Work History
Complex Customer Care Representative
United Healthcare
Remote
01.2024 - Current
- Collaborate effectively with multiple internal partners to ensure issues are resolved and thoroughly communicated to providers in a timely manner
- Serves as the advocate for mm by demonstrating accountability and ownership to resolve issues
- Quickly and appropriately, triage, contacts from healthcare professionals (i.e. physician offices, clinics, billing offices)
- Seek to understand and identify the needs of the members, answering questions and resolving issues (e.g. benefits and eligibility, billing and payments, clinical authorizations, explanation of benefits, behavioral health)
- Research and dissect complex prior authorization and claim issues and take appropriate steps to resolve identified issues to avoid repeat calls/messages, escalations, and member dissatisfaction
- Strong multitasking to effectively and efficiently navigate thru many different systems
Fraud Investigator
TTEC
Augusta, USA
03.2023 - 01.2024
- Conducted reviews of flagged transactions and reports that showed potential suspicious activity.
- Utilized various tools such as databases and software programs to analyze large amounts of data quickly.
- Bank Of America
Lead Pre-K Teacher
Learning Ladder LLC
Martinez, USA
05.2013 - 07.2023
- Worked with special needs children along with their parents, and therapist.
- Met with administrators and department team members to work on curriculum planning and assessment methods.
- Created and enforced child-based, hands-on curriculum to promote student interest and receptive learning.
- Organized creative and fun activities, enhancing children's physical, emotional and social well-being.
Insurance Representative
Teleperformance
Augusta, USA
10.2010 - 08.2013
- Maintained updated knowledge through continuing education and advanced training.
- Created an environment conducive to learning by displaying appropriate materials around the classroom.
- Built and strengthened positive relationships with students, parents and teaching staff.
- Explained coverage options to potential policyholders, answering questions or concerns.
- Maintained pleasant and cordial attitude, remaining calm when issues arose.
- Blue Cross Blue Shield
Education
Associate of Science - Early Learning And Child Care
Augusta Technical College
Augusta, Georgia, GA05-2021
GED -
Augusta Technical College
Augusta, Georgia, GA05-2013
Diploma - Medical Assisting
United Education Institute
Augusta, Georgia, GA05-2011
Skills
- Fraud Investigation
- Risk Analysis
- Customer Service
- Conflict Resolution
- Data Analysis
- Curriculum Development/Teaching
- Healthcare Insurance Support
- CRM Systems, Windows
- Call center experience/Phone etiquette
- Email communication
Timeline
Complex Customer Care Representative
United Healthcare
01.2024 - Current
Fraud Investigator
TTEC
03.2023 - 01.2024
Lead Pre-K Teacher
Learning Ladder LLC
05.2013 - 07.2023
Insurance Representative
Teleperformance
10.2010 - 08.2013
Associate of Science - Early Learning And Child Care
Augusta Technical College
GED -
Augusta Technical College
Diploma - Medical Assisting
United Education Institute