Customer Service Benefit Plan
Resume:
Catherine Napier
Topeka, KS *****
ad1xbl@r.postjobfree.com
Authorized to work in the US for any employer
Work Experience
CSR II / SME / Trainer
CVS CAREMARK - Lees Summit, MO
October 2020 to Present
• Creates an emotional connection with our members by understanding and engaging the member to the fullest to champion for our members' best health.
• Taking accountability to fully understand the member’s needs by building a trusting and caring relationship with the member.
• Anticipates customer needs.
• Provides the customer with related information to answer the unasked questions, e.g. additional plan details, benefit plan details, member self-service tools, etc.
• Uses customer service threshold framework to make financial decisions to resolve member issues.
• Explains member's rights and responsibilities in accordance with contract.
• Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target system.
• Educates providers on our self-service options; Assists providers with credentialing and re-credentialing issues.
• Responds to requests received from Aetna's Law Document Center regarding litigation; lawsuits.
• Handles extensive file review requests.
• Assists in preparation of complaint trend reports.
• Assists in compiling claim data for customer audits.
• Determines medical necessity, applicable coverage provisions and verifies member plan eligibility relating to incoming correspondence and internal referrals.
• Handles incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management. Performs review of member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible.
Answers questions and resolves issues as a “single-point-of-contact” based on phone calls, plan sponsors, PSS/ISO, members and providers. Provides customized interaction based on customer preference and individualized needs, creating an emotional connection with our members by understanding and engaging the member to the fullest.
• Fully understands the member’s needs by building a trusting and caring relationship with the member.
• Anticipates customer needs. Provides the customer with related information to answer the unasked questions, e.g. additional plan details, benefit plan details, member self-service tools, etc.
• Uses customer service threshold framework to make financial decisions to resolve member issues.
• Educates and assists customers on various elements of benefit plan information and available services created to enhance the overall customer service experience with the company (i.e., assistance with member self-service tools, Consultation Opportunities – Simple Steps, Cost of Care Tools, Natural Alternatives Program, etc.).
• Utilizes all relevant information to effectively influence member engagement.
• Takes immediate action when confronted with a problem or made aware of a situation.
• Takes ownership of each customer contact to resolve their issues and connect them with additional services as appropriate.
• Identifies member needs beyond the initial inquiry by answering the unasked questions.
• Resolves issues without or with limited management intervention.
• Provides education to members to support them in managing their health.
• Responds quickly to meet customer needs and resolve problems while avoiding over-committing.
• Other activities may include: providing claim status information, benefit coverage interpretations, and explaining plan eligibility.
• Processes claim referrals, new claim hand-offs, and escalates issues as appropriate through the system for grievances and appeals.
• Initiates out-reach/welcome calls to ensure constituents expectations are met or exceeded. Identifies trends and any emerging customer service issues and works to develop solutions to address potential problems and/or plan features of interest as an approach to improve understanding of benefit plans and increase post-enrollment member satisfaction.
• Answers questions and resolves issues as a “single-point-of-contact” based on phone calls, plan sponsors, PSS/ISO, members and providers. Provides customized interaction based on customer preference and individualized needs, creating an emotional connection with our members by understanding and engaging the member to the fullest.
• Fully understands the member’s needs by building a trusting and caring relationship with the member.
• Anticipates customer needs. Provides the customer with related information to answer the unasked questions, e.g. additional plan details, benefit plan details, member self-service tools, etc.
• Uses customer service threshold framework to make financial decisions to resolve member issues.
• Educates and assists customers on various elements of benefit plan information and available services created to enhance the overall customer service experience with the company (i.e., assistance with member self-service tools, Consultation Opportunities – Simple Steps, Cost of Care Tools, Natural Alternatives Program, etc.).
• Utilizes all relevant information to effectively influence member engagement.
• Takes immediate action when confronted with a problem or made aware of a situation.
• Takes ownership of each customer contact to resolve their issues and connect them with additional services as appropriate.
• Identifies member needs beyond the initial inquiry by answering the unasked questions.
• Resolves issues without or with limited management intervention.
• Provides education to members to support them in managing their health.
• Responds quickly to meet customer needs and resolve problems while avoiding over-committing.
• Other activities may include: providing claim status information, benefit coverage interpretations, and explaining plan eligibility.
• Processes claim referrals, new claim hand-offs, and escalates issues as appropriate through the system for grievances and appeals.
• Initiates out-reach/welcome calls to ensure constituents expectations are met or exceeded. Identifies trends and any emerging customer service issues and works to develop solutions to address potential problems and/or plan features of interest as an approach to improve understanding of benefit plans and increase post-enrollment member satisfaction.
• Partners with other departments to deliver client specific presentations.
• Coordinates efforts both internally and across departments to successfully resolve service issues and develop process improvement intended to enhance the overall delivery of service.
• Works collaboratively with colleagues to deliver the best customer experience,.
• Seeks to understand the customer, including circumstances, problems, expectations and needs.
• Asks probing questions to identify the underlying customer needs.
• Appropriately transitions conversations to explore possibilities for extending customer interactions.
• Guides members to the appropriate health resource. Offers alternatives where appropriate .
• Acts with the best interest of customer in mind and central to all interactions.
• Collaborates with colleagues and co-workers to deliver a world class customer experience.
• Serves as SME providing technical assistance when needed on call related issues, products, and/or system applications delivery matters.
• May participate in preparation and presentation of client specific presentations.
• May track and trend data. Coaches, trains and assists in the development of call center staff, as required.
• Participates in and/or leads special projects/initiatives addressing service issues, as necessary.
• Provides technical or subject matter expertise concerning policies, procedures, and function-related applications/systems tools as needed.
• Delivers internal quality reviews.
• Provides appropriate support in third party audits when required. Documents and tracks all contacts, events, and outcomes with clients using appropriate systems and processes Also helps with new hire classes to train new employees. Mental/Behavioral Health Technician
KVC Health Systems - Kansas City, KS
September 2019 to Present
Responsibilities:
• Supervise youth at all times to ensure basic needs are being met
• Assist youth through completion of daily responsibilities, activities and living skills
• Engage and build relationships with youth
• Support youths’ emotional needs and teach new social skills
• Responsible for keeping the Residential Homes safe, clean and orderly
• Provide needed support to improve treatment outcomes CPR Certified
SCM (Supply Chain Management) Trained
Teacher's Aide/Paraprofessional
USD 290 - Ottawa, KS
August 2017 to August 2019
I helped teach troubled teens 9th-12th graders at an Alternative High School at USD 290 Ottawa, Kansas. I completed attendance, assisted students with their class work, grading, leading small group instruction, supervising all students and preparing classroom materials. I assisted with students to understand what there learning in all school subjects, I also assisted the students with all tests so there able to understand them and pass them so students were able to obtain their high school diploma. Administrator/Secretary/Telephone Service Representative Dispatcher/ Supervisor
Answer Kansas City
February 1994 to November 2016
Medical Receptionist/Office Administrator
Answered phones for companies away from their phone & after hours companies
• Data Entry
• Order entry
• Medical Billing
• Assisted with taking care of overflow and after-hours/out-of-office calls
• Paged Doctors and On call Maintenance for after hours emergencies
• Remote Receptionist Services
• Order Entry and Web Enabled Order Entry
• Help desk
• Application Completion
• Dealer locator Services
• Reservation and Appointment Setting
• Fax Services
• Voice mail Services
• AP/AR
• Computer Operator: Microsoft Office, Windows 7 & 10
& NT, Excel, Power point and database operations
Collector
Convergy's
June 2010 to May 2011
A/P and A/R
- Contacting customers through the use of an auto dialer system
- Following up on promises
- Ability to work in a fast-paced environment
- Ability to communicate in a respectful and assertive manner
- Ability to multi task and prioritize while speaking with customers
- Counsel delinquent debtors to assist in finding funds to meet debt obligations
- Knowledge, understanding, and compliance with all applicable Federal laws and regulations that regulate the collection industry FDCPA
- Exceed industry and client performance expectations/ recovery rates
- Skip Tracing
- Account Management
Assistant Sales Manager
Macy's Midwest
July 2007 to December 2009
Assist associates to make sure work flow is smooth.
- Assist and coach associates with questions or concerns with customers to make the best possible decision.
- Assist associates with credit applications for customers.
- Zoned various departments to make sure every associate is getting their tasks and goals accomplished.
- Goals and loyalty goals that have to be met every month.
- Screen and interview new applicants
Major Tasks
- Maintaining good customer service and store appearance
- Receiving, stocking, and pricing merchandise and maintaining stock files and reports
- Maintaining inventory quantities to ensure accurate product orders Education
Associate in Criminal Justice
Post University - Waterbury, CT
July 2017 to Present
Associate of Cosmetology in Cosmetology
Z Hair Academy - Overland Park, KS
2015 to 2016
High school or equivalent
Park Ridge Private School - Long Beach, CA
Skills
• Retail Management, Customer Service, cash handing, Microsoft Word, PowerPoint and Microsoft Excel (2 years)
• Teacher Aide
• Teacher Assistant
• Babysitter
• CPR Certified
• Case Management
• Documentation
• Management
• Microsoft Excel
• Microsoft Office
• Powerpoint
• Receptionist
• Microsoft Windows
• Order Entry
• Behavioral Health
• Help Desk
• Supply Chain
• Accounts Receivable
• Microsoft Word
• B2B Sales
• Typing
• Microsoft Outlook
• Crisis Intervention
• Sales Management
• Medical Receptionist
• Group Therapy
Certifications and Licenses
Driver's License
CPR Certification
First Aid Certification
Additional Information
Leadership Skills:
-On the job trainer Helped train on New Sales
computer system to Windows NT
- Ability to develop and train employees through communication of rules and establishment and enforcement of performance standards
Reasoning: Ability to plan, prioritize, set goals, make decisions, and solve problems
-Team Leader: had a team of a minimum of 10
people to assist.
- Team Work: Ability to work well with others to achieve common goals Skills & Strengths:
-Excellent team & Professional skills.
-Excel in Marketing areas.
-Computer Operator: Microsoft Office, Windows 7 & 10 & NT, Microsoft Excel and Microsoft Word, Power point and database operations
Contact this candidate