Customer Service Representative

Ramona Morris

Interview Availability: ** Hours prior notice, can start as soon as possible

Summary:

Professional Customer Care Service / Customer Service Representative / Support Representative who has 10+ years of experience in providing customer service and 3 years of experience in Medicare.

Well-versed in escalating benefit verifications and creating Prior Authorizations.

Strong experience in the Pharmacy, Major Medical, Prior Authorizations, Medicaid / Medicare, and Benefit Verification.

Hands-on experience in participating in team meetings, conference calls, Zoom meetings, etc. remotely / locally with administrators and the audit team as necessary.

Well-versed in working collaboratively within the team as well as with other internal and external customers.

Experienced in Retail Customer Service Client Retention.

Hands-on experience in interacting directly with clients and responding to client requests, developing strong relationships with clients.

Proficient in Microsoft Office (Word, Excel, PowerPoint).

Strong communication and writing skills.

Work Experience:

Remote Customer Service Representative

Capgemini – Pittsburgh, PA

Nov 2021 to Nov 2023

Validate that the coverage of a claim and the payment of such claim is in compliance with the contractual, regulatory, and custom plan guidelines.

Validate the proper PAP Cards/ Methods of payment and pharmacy rebates to a client per the contractual arrangement.

Escalate benefit verifications, and create Prior Authorizations.

Medicaid / Medicare.

Benefit Verification.

Validate pharmacy claim payment data to validate conformance with contractual requirements and plan specifications as assigned.

Work collaboratively within their team as well as with other internal and external customers.

Participate in team meetings, conference calls, Zoom meetings, etc. remotely / locally with administrators and the audit team as necessary.

Interact directly with clients and respond to client requests, develop strong relationships with clients.

Remote Escalation Specialist – From Home

AMAZON/AMZL – Pittsburgh, PA

Nov 2014 to Nov 2021

Remote Escalation Specialist role- Support Delivery Stations to ensure on-time delivery from the Fulfillment Centers to ensure Customer expectations of the Delivery date and time.

Escalate the delivery time and date.

Address Validation Associate Role - Over the road/eyes on validation of Commercial and Residential Customers to ensure proper delivery by AMZL and DSP Drivers.

Address Validation also helps AMZL and DSP Drivers find and deliver to Customers with no returns or “GPS stress”.

Address that have issues are populated on the easel app and the AVA validates the correct address, parking location, and the location the Customer wants drivers to deliver to on the property and identify all signage that will also help drivers locate the correct Commercial and Residential Customer locations.

Full-Time Shift Assistant Role- Daily management of department duties, including allocating labor, leading meetings, assigning job duties, providing work direction, and communicating with internal and external suppliers.

Provide vacation coverage for Area Managers.

Track and report of ATS/labor hours.

At times assist with production duties, train associates, and verify SOP compliance.

Ensure successful area performance, through tracking and reporting metrics.

Independently assess all aspects of associate work performance and provide feedback.

Participate in Operational Excellence initiatives.

Fully understanding workflow and daily production goals.

Review and update SOP as required.

Ensure work areas remain clean and are equipped with proper equipment and supplies.

Identify and address safety hazards within the work area.

Coach associates to work safely at all times.

Participate in safety initiatives.

Ensure all job injuries are reported timely in accordance with established policy and procedure.

Ambassador Role - Coach, mentor and train Associates on standard work and operation processes to be on the offensive to deliver complete customer satisfaction and ensure the Associate's safety and well-being by auditing the Associate's standard work processes and correcting the coaching program.

Education:

MBA in Operations Management, Marylhurst University - Marylhurst, OR – September 2008 to March 2010.

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