Customer service representative
Resume:
Rosetta Mckenzie
southgate, MI *8195
**********@*****.***
OBJECTIVE
SUMMARY OF QUALIFICATIONS Deals tactful with people in a wide variety of situations to convey a favorable corporate image. Respond to all customers in a polite and courteous manner and demonstrate professionalism while working with difficult customers and/or issues of a sensitive nature. Excellent problem solving skills including the ability to understand and explain complicated inquiries. Ability to handle multiple tasks and meet deadlines. Working knowledge of medical and insurance terminology to determine pre-authorization or referral requirements.
RELEVANT SKILLS & EXPERIENCE
Strong Customer Service experience
Working with benefit packages, Leadership abilities, Strong written and verbal communication
EMPLOYMENT HISTORY
Interviewer/Survey Clerk, Morpace Farmington Hills, Michigan 02/2018-Present
Interview commerical account clients with ford credit for fleet and commerical new used vehicles with business owners. Gathering source of information with accurate, reliable and dependable completely. Working with focus groups and Product clinic for client to get feedback and gather information for marketing and business needs. Outbound call center contact healthcare providers for home health care facilities regarding return and completion of surveys for data research firm having a consistenlty high production record.
Benefits Call Center Representative, Conduent Allen Park, Michigan 10/2017-12/2017
Responds to telephone inquires regarding client benefits.
Responsible for the day to day service and administration of benefit plans for assigned clients using established procedures and detailed instructions.Communicates appropriate options for resolution in a timely manner.informs customers about services available and assesses customer needs.
Performs benefit calculations where required maintains benefits member data base.
Prepares benefits statements and year end updated of benefit records.
Provides basic advice and guidance to clients or pan members.
Assist employees in the completion of appropriate forms, calculation of benefits or premiums.
Liaises with actuarial staff, senior consultants or senior administrator/manager, as well as trust company and insurance company representatives.
Monitors priority of calls and escalated calls to assure resolution to problems.
Prepares standard reports to track workload, response time and quality of input.
Customer Service Representative, JMS and Associates Farmington Hills, Michigan 02/2017-06/2017
Call center representative taking incoming calls to assist provider with eligibility of benefits.
Pre certification for inpatient surgery, mri,cat scans, inpatient mental health, authorization for new born after delivery if more than 96 hours after birth still inpatient at hospital,
benefit plan information including deductible, out of pocket maximum. Co-insurance, patient responsibilities amounts.
Gave claim status, refer to auditors for reprocessing of claims and review of denied claims when necessary.
Assist providers with request for eob and vob to be faxed, refer providers to provider maintence when npi numbers needed to be updated and W9 forms.
Durable Medical Equipment, injections, medical supplies.
Restat and Magellan pharmacy vendors.
PPO, PHCS plans COB and Medicare as primary insurance carrier.
Usage of Luminex system.
Document Alias Analyst, Quicken Loans Detroit, Michigan 04/2015-01/2017
Extract essential information that is requested from the underwriter before it has been reviewed
responsibilites include aliasing pre selected documents assesses W2 forms retirement accounts.
Job responsibilities with a high level of detail.
Income verification, mortgage payments. Including bank statements, 401k statements
Proficient in Microsoft office, excel, word, PowerPoint and outlook.
Knowledgeable of priorities and how they impact internal client service.
Operations department.
Business Analyst, Health Alliance Plan Detroit, MI 03/2014-08/2014
My responsibilities included: reviewing, identifying and Disseminating Enrollment and Billing discrepancy
DOB, Gender, HICN, LIS, PWO and SCC that the Plan experienced between IKA (Medicare Advantage Enrollment)
including Facets Fixes, Reports. Also, worked closely with IT Teams that supported the 2013 Program Audit Cap within the expedited timeframe for CMS audit report and corrective action plan which was completed July, 2014 with the government enrollment Medicare Advantage & Direct Pay department at Health Alliance Plan
Technical Business Analyst, Precepta Dearborn, Michigan 07/2013-10/2013
Technical Business Analyst with Ford Motor Company In-Vehicle Technology Team.
Working with new customers who had purchase a vehicle with Sync system. Assisting customer with paring iPhone and smartphone to vehicles.
Enable Bluetooth devices and text message notifications; Wi-Fi Settings.
Troubleshooting customer issues with maps and directions features, downloading phonebook to Sync system for hands free access to all incoming and outgoing calls while driving vehicle.
Explaining My Ford Touch System features and functions of all applications including navigation, entertainment and climate controls. Reset clock to GPS time.
Ordering Vehicle Health Reports. Discussing rear view camera setting and usage. Travel link and alerts.
Help customer with setting wallpaper and adding photos, Self-service channels and usage of voice commands
Program Specialist, Pitney Bowers Farmington Hills, Michigan 06/2012-08/2012
Receives calls which are with limited response adaptation required Possess a thorough knowledge of rewards link can provide detailed information to customers Has fluency in responding to common questions asked of customers.
Reads and researches relevant materials and resources stay current in program Utilizes prescribed quality call handling processes. Met specific performance standards services to improve customer product knowledge.
perform some outbound follow up as required Initiates customer fulfillment requests via standard procedures and/or third party contact Answers customer questions. Conducts warm transfer of calls to functional specialist for more detailed information on product areas.
Assist Sales Associates with Trade Customers login and password. Advised Market Managers of adjustments for SKU's entered online for all Sales Associates locations.
Heavy usage of IVR system and programs related to reward links, Familiar with self-service channels and related software including web designs etc.
Client Service Representative, Budco Highland Park, Michigan 10/2010-02/2011
Inbound Call center answering customer’s questions and concerns regarding billing, claims premiums for Health Alliance Plan, Medicare Advantage Plans for Medicare Part D, and HAP Extended POS for residents of Michigan.
Usage of Phone systems Paradigm, HITS programs and support modules.
Discussing wage works for automotive company’s retirees eligible for reimbursement of medical expenses.
Resolving customers issues with pharmacy refills, emergency five day RX and over riders. Drug tier formularies. Appeals process.
Inquiry Specialist, Blue Cross Blue Shield of Michigan Detroit, Michigan 03/2010-06/2010
Inquiry specialist answer provider inquiries for precertification department at Blue Cross Blue Shield of Michigan.
Medical inpatient hospital admissions. Surgery, Mental Health and Acute care, Long term acute care. Working with nurses and doctors reviewing admissions to provide authorizing for all inpatient hospital care, including skilled nursing admission and rehab services.
use of the Prism and Nasco systems to research profiles and health care benefits for members living in the United States and for Michigan residences.
Out of Network inquires giving authorization to providers and members.
Enrollment Specialist Sales & Marketing, Blue Care Network Southfield, Michigan 09/2008-01/2009
Responsibilities included assistance in walk in center answering question from prospects interested in joining the BCNA Medicare advantage plan.
Enrollment in BCN Advantage and Medicare Plus Blue health plans for retirees.
Blue card and advised clients how to log in and usage of the website.
reset members passwords and steps to take to navigate benefit packages to make elections during open enrollment or Special enrollment period.
EDUCATION & TRAINING
Diploma, Business, Chadsey High School, 5335 Martin St Detroit, Mi 48210, Four year(s)
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