Customer Service Quality Assurance

Angelica S. Smith

*** *.*. **** ******

Fort Lauderdale, FL 33311

Email: *****************@*****.***

Phone: 954-***-****

OBJECTIVE: To obtain a position within an organization that offers security and professional

growth which requires strong analytical, technical and customer service skills.

EXPERIENCE:

Sept 08 – Aug 13 Alere Healthcare Inc. Sunrise, FL

Care Manager Assistant

• Initial point of contact for clients/providers

• Receives new referrals, verifies member eligibility, build cases and assign

to appropriate care managers.

• Receives/enters data for new/current patients.

• Contacts care managers to obtain/maintain current information according

to company policy, state and federal regulations.

• Prepares clinical records and/or nonclinical information upon receipt of

referral or in support of enrollment process based on client specific

workflows.

• Responsible for provider enrollment

• Maintain reminder list to ensure letters and educational materials are sent

in a timely manner.

• Input, Verified, and updated credentials for all medical staff

• Contact physician offices to follow up on receipt of faxed requests for

clinical information.

• Verify physician office information.

• Obtain clinical information verbally if physician office does not complete

and return the initial faxed request

• Assist with any project that is deemed critical, such as managing inbound

and outbound faxes.

• Perform quality assurance measures on the mail packets to ensure

diagnosis appropriate material is included in the participant’s package and

sent only to authorized members.

• Provide detailed information to new members about the care management

program and ask qualifying questions to see If member qualify and try to

get member to sign up to be able to assist them to manage their health.

Aug 05 – Sept 08 Healthcare Advantage Plantation, FL

Health Benefit Coordinator

• Provided clients with the benefits of their discount health plan.

• Assist them with choosing a doctor in their area within our network and schedule

them for yearly exams, mammograms and other specialist appointments.

• Provided clients with directions, date and arrival time and special instructions if

needed upon visit as well as collecting payment percentage upon confirmation

Jun 02 – Jul 05 Metro 1 Telecommunications Sunrise, FL

Supervisor/411 operator

• Assisted with escalated calls

Provided customers with directory assistance

• Provided customers with driving directions as well as movie times

• Took inbound calls also made outbound calls as needed

• Assisted with training and development of new employees

• Assisted with supervisor calls

• Developed monthly focus groups to improve the call center work

flow.

Jan 99 – April 02 Apollo eye associates Boca Raton, FL

Customer service/Insurance verifier

• Assisted customers to find local eye doctors

• Verified insurance coverage

• Schedule Appointments

• Assist customers with questions about insurance coverage

• Received inbound calls and made outgoing calls

• Assisted with insurance writeoffs and medicare

EDUCATION: Seagull High School All required subjects

Available upon request

REFERENCES:

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