Yvonne Briggs
Sacramento,CA
Summary
To be part of a company that indulges professional growth, which provides challenging /rewarding career while allowing me to utilize my knowledge and skills. Creative customer care professional dedicated to consistently surpassing service goals with unparalleled support for customer needs. Smoothly manages both incoming and outgoing calls and remote requests by applying strong organizational, research and time management skills. Solid history of success in fast-paced call centers.
Overview
16
16
years of professional experience
Work History
Member Service Representative
PORAC , Insurance Benefits and Trust
02.2025 - Current
- Helped large volume of member's every day with positive attitude and focus on customer satisfaction.
- Assisted members with correcting account, service, claims and pre cert/ auth research.
- Handled complaints with prompt, courteous service to uphold professional reputation.
- Educated member's on how to download EOB, and research claims on Anthem.com or ISITE.
- Verify Benefits, Quote plans, and Mail Dental and Vision information packets.
- Assist member's with calling providers or facility for paid claims research payment.
Member Service Representative
Western Health Advantage
03.2024 - 02.2025
- Helped large call volume everyday answering over 50-60 per day.
- Assisted members with benefits, claims and provider search.
- Resolved member issues through thorough dispute investigation/ Appeals and grievances.
- Verified Eligibility and Termination date for coverage.
- Assisted provider's with Medical or DME claims.
- Reviewed Rx drug coverage.
Customer Care rep
Prime Therapeutics Inc
11.2021 - 10.2023
- Inbound calls average 50-60 calls daily
- Review Drug coverage claims
- State Medicaid and Medicare Part D claims- Prescription drug coverage
- Reviewing claims for Provider's, Pharmacy and Beneficiaries
- Verbal Authorizations from Beneficiary's
- Prior Authorizations request review- Approval or Denial.
- Prescription Drug claims denied or paid.
- Transferring Beneficiary's to appropriate Managed care Plans.
- Researching Medical and transfer to County office
- Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
- Responded to customer needs through competent customer service and prompt problem-solving.
- Logged call information and solutions provided into internal database
Customer Services Agent
Aetna Medicare
04.2020 - 10.2021
- Medicare PPO and HMO Health Plans
- Review Medical Claims for Provider's
- Email and Fax
- Inbound calls on daily average 45-80 calls daily
- Transferred to appropriate Department for review of hospital or medical claims.
- Request claims to be reviewed for possible under payment
- Outbound calls to Provider's
- Entered customer interaction details in sales system to track requests, document problems, and record solutions offered
- Educated clients on account services and resolved client inquiries regarding statement information and account balances
Customer Service Rep
Cubic Transportation Inc
06.2019 - 09.2019
- Inbound call center average calls daily 80-90
- Processed order's for Clipper Cards, Seniors, Youth and Disabled
- Processed Payments Bus, Trains and Bart Fares
- Issued refunds and or credits
- Cancelled Lost/ Stolen Cards
- Registered Clipper Cards Online
- Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
Customer Service Rep
SFHP
02.2019 - 04.2019
- Answered 50-60 calls daily speaking with member's regarding their heal plan and coverage.
- Mailed medical/ health plan surveys.
- Called to make sure members received their Survey's and mailed back in timely manner.
- Assisted member's in completing forms.
- Notated accounts when forms are received.
- Noted messages for CSR Reps, while taking other calls
- Email, Fax, Print and Mail.
Customer Service Rep
Zenith American Solutions
03.2014 - 10.2018
- Average Calls Daily 90+ calls
- Responded to questions relating to claims
- Instructed provider's on filing Appeals
- Reviewed employee benefits
- Verified Eligibility with Beneficiaries
- Assisted provider's with access to online info from TC3, Change HealthCare, Emdeon, get next or ICM
- Reviewed 80-100 claims UB04, and HFCA/1500 for accuracy and ensure coding is correct
- Offered advice and assistance to customers, paying attention to special needs or wants.
Benefit Specialist
07.2013 - 12.2013
- Respond to 50-60 calls and enrollment inquiries
- Assisted with Windstream employee's with Annual Benefit Enrollment
- Reset Passwords and Username/ ID's
Customer Care Agent
Vangent, Inc
06.2009 - 03.2012
- Inbound calls 100-200 + on daily basis
- Reviewed professional and facility claims and provide status on if claims was paid.
- Medicare Part A/B, and Part D drug claims
- Enrolled into Medicare Advantage plan or Drug Plans
- Assisted with Prescription drug coverage.
- Verified and Checked Medicaid Benefits, Ordered Medicare Card, Assisted with Medicaid Extra Help for Drug Coverage
- Submitted Authorization forms.
- Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
- Logged call information and solutions provided into internal database.
Education
High School Diploma -
Stratford Career Inst
Washington, DC2007
Skills
- Information Extraction
- Correcting Discrepancies
- Customer Database Management
- Greeting Caller's
- Tracking complaints
- Document processing
- Customer service
- Call center experience
- Healthcare
- Complaint handling
Timeline
Member Service Representative
PORAC , Insurance Benefits and Trust
02.2025 - Current
Member Service Representative
Western Health Advantage
03.2024 - 02.2025
Customer Care rep
Prime Therapeutics Inc
11.2021 - 10.2023
Customer Services Agent
Aetna Medicare
04.2020 - 10.2021
Customer Service Rep
Cubic Transportation Inc
06.2019 - 09.2019
Customer Service Rep
SFHP
02.2019 - 04.2019
Customer Service Rep
Zenith American Solutions
03.2014 - 10.2018
Benefit Specialist
07.2013 - 12.2013
Customer Care Agent
Vangent, Inc
06.2009 - 03.2012
High School Diploma -
Stratford Career Inst
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