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Click here or scroll down to respond to this candidateCandidate's Name
Street Address Lincoln stChester,PA Street Address
PHONE NUMBER AVAILABLEEM: EMAIL AVAILABLEEducation: Mount Pleasant High School, DiplomaCheyney University, Still SeekingProfile: Strong background in all aspects of Customer Service and Support, Interpersonal and Communication.Objective: Seeking a position utilizing my extensive knowledge and successful experience in a position offering opportunities for personal contribution and professional growth.Related Coursework : Intro to Criminology, First Aid & CPR, Basic Principle of Computer, Economics, Physical ScienceSystems Knowledge: Microsoft Word, Excel, PowerPoint, Cotiviti Claim Inquiry Tool (CIT), NaviNet, COB Lookup, NPI Xwalk, Client Access System.Line of Business experience: LOB 100- Keystone First, LOBs 500/530/540- AmeriHealth Caritas Pennsylvania, LOB 2600 - Blue Cross Complete of Michigan, LOB 7200- AmeriHealth Caritas Pennsylvania Community HealthChoices (CHC), LOB 7200- Keystone First CHCChristiana Care: Wilmington, DE-TemporaryCustomer Service RepresentativeMarch 2023 July 2023Serve as an open enrollment customer service representative specialist.Demonstrating exceptional customer service skills while accurately responding to high volumes of calls.Answer questions about each benefit program while educating individuals about their benefitsInvestigate and respond to all customer inquiries utilizing available resources provided.Function as a liaison between Benefits and the caregiver ensuring benefit enrollment is accurately captured in a timely manner.Logs detailed and accurate information on calls received in the case management system.Interprets and responds clearly and effectively to all verbal or written requests for information.Demonstrates sound judgment in escalating cases to the appropriate subject matter experts.Demonstrate the ability to deescalate calls.Navient Solutions: Wilmington,DE-RemoteSeptember 2022- March 2023Take inbound calls from private loam borrowers to obtain paymentMake outbound calls on a dialer system to obtain payment from private loan borrowers and or co signersSet up payment arrangementsEnroll borrowers into different loan programs to resolve delinquent accountsFollow up on accounts in a delinquent statusUpdate or change personal information on accountsLook up borrowers in clearinghouseAmerihealth Caritas: Philadelphia, PA August 2019-August 2022Analyze claims to determine extent of companys liabilityMake approval or denial decisions and negotiate settlements with claimants in accordance with policy provisionsCompleted more than 3,500 claims throughout tenureProvided optimum service to policyholdersAchieved the highest number of Claims AdjustmentSurpassed goal by averaging monthlyMaintained a superior quality rating of 98% in file handlingClaims resolution of 98% departmental goalUtilize systems to provide quality performance standardsIdentify any issues by problem analysis and strategies to make a resolutionClaims processing knowledgeUtilize Facets system, State system, working knowledge of Microsoft Office applications; experience in call center ops and member/provider database maintenance preferredLocate a Prior Authorization in JivaLocate a Provider Dispute/Appeal (PCS)Provider Remittance Advice RequestsChange Healthcare (formerly known as Emdeon) is the health plan's vendor for electronic claims submissions.Provider-Initiated TPL Recovery RequestsReviewing Claims Denied for No AuthorizationService iHealth Clinical Editing CallsDelta T Group : Bryn Mawr, PARecruiter July 2017- August 2019Provide a positive customer experienceTake inbound and outbound callsRespond to and follow up on daily correspondence and voicemail messagesAssist customers with a wide variety of questions and/or concerns pertaining to their accountAssist customers with tasks such as making payments over the phone, setting up web login or password, resending invoicesCreate a positive customer experience (NPS)First call resolution ensuring that the inquiries have been addressed to the customers satisfaction by using all resources in an efficient and timely manner.Training incoming new employeesMy Alarm Center: Newton Square, PAAccounts Receivable Representative August 2014- July 2017Provide a positive customer experienceAnswer incoming calls and make outbound callsRespond to and follow up on daily correspondence and voicemail messagesAssist customers with a wide variety of questions and/or concerns pertaining to their accountAssist customers with tasks as making payments over the phone, setting up web login, password, invoicesCreate a positive customer experience (NPS)First call resolutionTraining incoming new employeesSecurity Alarm Monitoring: Woodlyn, PADispatcher: October, 2012-August 2014Taking incoming and outgoing calls to clientsDispatch police and fire department for 911 callsDocument necessary forms about incidentsFiling necessary paper for logging day to day tasksMonitor and respond to security signalsUniversal Atlantic Systems: Broomall, PADispatcher: March 2012- June 2013Taking incoming and outgoing calls to clientsDispatch police and fire department for 911 callsDocument necessary forms about incidentsFiling necessary paper for logging day to day tasksMonitor and respond to security signalsTrain incoming employeesFax paper to clients and respond via emailAbbott Diabetes Care: Langhorne, PACall Center Representative, March 2011-August 2011Take calls from customersSolve problems for customer the productsDocument all callsEducate customer about the productsPresent and project a positive image of the company in and out of the officeDemonstrate passion for providing superior customer service to our customers and continually seeks to understand the needs |
