Customer Service Representative

Rebecca Cunningham

*** ***** **** ******, ** ****6 920-***-**** ******@***.***

Summary

I am seeking employment in a vital, industry-leading company where I can put into everyday use my traits of empathy, compassion, and professionalism; my excellent written and oral communication skills; and my attitude of being positive, adaptable, and enthusiastic. I am committed to interacting with both internal and external contacts in a way which is effective and fair to achieve the goals of the team.

Experience

Supervisor, Prior Authorizations 05/2015-08/2016 Navitus Health Solutions, Appleton, WI

This department processed the requests for medications outside of the normal coverage limits of members' pharmaceutical benefits for Commercial, Exchange, Medicare D, and Medicaid clients. Responsibilities included supervising the PA mailroom and two direct reports with regard to the daily processing of decision letters meeting requirements for HIPAA, accuracy, and timeliness; maintaining employee attendance and performance records; involvement with implementation of new PA processing system; on-boarding, training, and oversight of tasks of two coordinators and a summer intern; interviewing department candidates; delivering yearly reviews; meeting with direct reports and agents for coaching and disciplinary issues; pulling calls and implementing reports to address learning opportunities; resolving escalated calls from members and clients; researching privacy incidents and reporting to Compliance; department training; responsible for various other department needs on an ad-hoc basis.

Team Lead, Customer Care 07/2014-05/2015 Navitus Health Solutions, Appleton, WI

Functioned as a resource to trouble-shoot agents' problems, questions, and escalations on calls, answering immediately or reaching out to other departments as necessary; researching calls logged as complaints; researching privacy incidents; going over claims and being to calculate complex co-pay and benefit questions; responsible for call coaching of team of six agents per month- critiquing calls and writing up results for purposes of developing agents' skills; answering calls during times of high volume; leading refresher training courses.

Member Services Specialist 03/2010-07/2014 Navitus Health Solutions, Appleton, WI

Fielded calls from members, physicians, pharmacies, and clients regarding pharmacy benefits. Responsible for having a complete knowledge of benefit plans and the system resources available to answer an extremely broad range of questions in a timely, helpful, and professional manner; answering additional questions on specialty queues: Medicare D SME line, Client Services queue, Spanish queue, Mentor queue. Served in a remote capacity for two years, working from home a regular full-time shift as well as logging on after hours during emergency situations to support the 24/7 call center.

Customer Service Representative, Dental Benefits 01/2009-03/2010 Guardian Insurance (through Kelly Services)

Took member and provider calls for diverse population, answering calls regarding dental benefits and claims. Handling calls while adhering to strict metrics requirements; advising members of covered or non-covered services; researching claims status; fielding eligibility calls; giving comprehensive benefit breakdown to dental providers; having complete knowledge of plans.

Prior Experience

Worked as music educator in various capacities, including certified children’s instructor for Yamaha program and adult keyboard classes (Heid Music- Appleton); as well as teaching privately (voice and piano.)

Education

CPhT (Certified Pharmacy Technician) Current

Applied for and was chosen to participate in Navitus’ in-house Pharmacy Tech training program. Attended classes in-house, did at-home study of several hours each week. Passed exam in June, 2014 to attain certification. Renewed in June, 2016 by taking required Continuing Education credits.

Bachelor of Arts: Vocal Music 5/1983 UW Madison, WI

3.2 Cumulative GPA

Spanish

Possess conversational Spanish-speaking skills

Technical

Proficient in Microsoft Office suite

References

Furnished upon request

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