Customer Care Call Center
Resume:
April ****-Present
Karren Oyewobi
**** ******** ***** **** *** 717, Forney, Texas 75126 945-***-**** • ad2dp8@r.postjobfree.com
Objective
I have 7 years in a Health Care-Call Center. I’m very energetic, fluent in English. I work well with all group of personnel. Ability to learn new tasks, expediently seeking new positions. Which utilize my excellent teamwork abilities and, opportunity to become a positive aspect in a growing or well established company.
Key Qualifications
● Active listening
● Computer skills
● Customer service
● Leadership
● Problem-solving
● Team player
● Organizational
Work Experience
Molina Health Care
Customer Care Experience II-Claims Rep
● As a Provider Claims Rep- Abide by HIPAA, keep member’s PHI confidential. Answered inbound calls from Providers, Hospital, clinics and 3rd party callers. Assisted and answered questions about member’s denial claims/billing. Assisted if a claim needed a Prior Authorization on file, contacted UM dept if needed, assisted with CPT-CODEs in the Prior Auth look-up tool. Assisted with paid claims, knowledge of check tracer as well QNXT, and ECHO. knowledge of UB04 and CMS 1500 form. Helped and explained the steps for appealing a denial claim, used the claim viewers to understand a denied claim, send claims for further review if needed. Explained the EOP and EOB to the caller.
● Customer Care Experience II- Abide by HIPAA, keep member’s PHI confidential. Answered 40- 50 inbound calls from Medicare member’s/family(POA). Assisted member’s and answered questions about their eligibility, explained their benefits they’re currently enrolled into. Checked and searched for In and Out of network Providers, explained the copay’s, deductible, and MAX OOP. Scheduled rides for their future appointments, assisted and explained denied billing. Contacted their PCP to update their Healthcare plans, assisted with appeals and file grievances for member’s complaints. Start the process for SSBCI, for qualified members. Assisted with DME supplies, and pharmacy calls. Update or changed PCP in salesforce, update demographics changes.
Continuum Global Solutions
Customer Care Representative
● As a CSR for Aetna Health Insurance CVS Caremark, we answers all inbound calls, for Medicare D members. Run test claims and refills all member’s medications through e-fax, or mailing medication orders. Outbound calls if needed, we also Warm transfer to the Senior Teams, or any other departments such as Prior Auth department. File an Grievance or claims for the members. Using the The PeopleSafe, The Source and other systems to help us navigate through the computer system. As well I was promoted to a different department, where I take inbound October 2023
2015
2011
calls, from members who wanted to order OTC products, and I will assist and order their products.
Education
College Of Healthcare Professional
Associate in HealthCare Management
Ashworth College
College Certificate
North Dallas High School
High School Studies
References
Available upon request.
Skills/Experience
● Medical terminology
● eMAR system
● EFax
● Copy
● Inventory
● Scanning
● Verify insurance
● MS word
● Excel
● 10-key
● PowerPoint
● Work From Home
● Warm Transfer
● Inbound calls
● Outbound calls
● ChartFinder
● HEDIS
● Medical Records
● Scheduling Transportation
● HIPAA
● Salesforce
● Pega
● Genesys
● QNXT
● CRM
● Verint
● Kronos
● Genesys
● Microsoft Office Professional (Excel, PowerPoint, Word).
● Microsoft Teams
● Video Conferencing
● Medicare
● Medicaid
● MMP/MSP
●CVS CAREMARK
●Medication Orders
●Test Claims
●CPT CODES
●CMS 1500
●UB04
Strengths
● Team player
● Reliable
● Independent
● Organized
● Responsible
● 10-key
● Great customer service
● Quick learner
● Strong Verbal and Written Communication Skills
Contact this candidate