*** **** ****** ****** **** * COVINA CA *****

424-***-**** EMAIL: ad419t@r.postjobfree.com

JOSHAKA ROBERTS

OBJECTIVE

Obtain a position as a team-leader in a people-oriented organization where I can maximize my 15 years plus customer-service and management experience in a challenging environment to achieve the corporate goals.

QUALIFICATIONS

Participate in managing the organization's Grievance, Appeal, and External Review process. Accountable for investigation and response of all issues, including collection of appropriate data, preparation, and presentation of documents to decision makers. Communicate with a diverse set of internal and external clientele to achieve excellent results in the area of case handling, compliance, documentation, and enhancement of the member experience. Partner with and outreach to internal staff, other MS Departments, managers, and physicians to resolve issues as quickly as possible. Participates in departmental meetings, training, and audits as requested Answers questions from members/advocates on existing/open cases Escalates issues to management as appropriate. Ensures regulatory compliance with the work product. Mentors others in preparation for positions of increased responsibility. Demonstrated conflict resolution and mediation skills with the ability to secure action from multiple stakeholders. Processing Kana case with the Client Service Unit. Processing employer and Broker requests. Claims and Service Billing. Team player, Type 65 WPM, Data Entry, MS Word and Excel, General Office, Receptionist, Internet Savvy, Sales and Marketing.

EMPLOYMENT

Kaiser Permanente, Rancho Cucamonga, CA

Employer Service Specialist II August 5, 2020, to Current

Payer contract interpretation for claim reimbursement

Assisted with Provider inquiries on contracting and credentialing status. Provide additional information when requested for credentialing requirements.

•Participate in managing the organization's Grievance, Appeal, and External Review process.

•Accountable for investigation and response of all issues, including collection of appropriate data, preparation, and presentation of documents to decision makers.

•Responsible for responding to members or their authorized representatives, physicians, and other stakeholders regarding the Health Plan's determination within regulatory timeframes while meeting quality and customer-focused standards.

•Communicate with a diverse set of internal and external clientele to achieve excellent results in the area of case handling, compliance, documentation, and enhancement of the member experience.

•Partner with and outreach to internal staff, other MS Departments, managers, and physicians to resolve issues as quickly as possible.

•Ensures appeals are processed and effectuated in accordance with regulations, compliance standards and policies and procedures.

•Meets timeframes for performance while balancing the need to produce high-quality work related to complex and sensitive member issues.

•Ensures integrity of departmental database by thorough, timely, and accurate entry.

•Mentors others in preparation for positions of increased responsibility.

•Participates in departmental meetings, training, and audits as requested Answer questions from members/advocates on existing/open cases and Escalates issues to management as appropriate.

•Ensures regulatory compliance with work product.

Kaiser Permanente, Corona, CA

Customer Service Rep III Jan 23, 2017 to August 5, 2020

Assist in the Client Service Unit: Research and resolve Employer and Broker Issues. Formulate solutions to complex and sensitive employer-initiated and broker-initiated concerns, using considerable discretion and independent judgment. Investigate circumstances surrounding purchaser issues and evaluating various courses of conduct.

Evaluates data to determine and implement the appropriate course of action to resolve the complaint and/or coordinate service recovery.

Eligibility Inquiry, Benefit Inquiry, General, Complaint, Correspondence Inquiry, Add/Remove Dependent, Service Review, New Member Experience, Internal Regional Request, IVR Defaults.

Service Billing: Billing Inquiry, Make Payments, Complaints, Payment Plan, General, Service Review

Claims: Claim Inquiry, Claim Referral Inquiry, Complaint, General, Provider Demographic Update. Service Review.

Wireless Watchdogs Culver City, CA

Customer Service Manager/Account Manager April 2007 to Jan 2016

create effective customer service procedures, policies, and standards, maintain accurate records, and document all customer service activities and discussions. They manage the customer service department's approved budget and stay informed on the latest industry techniques and methods.

Incorporated a ticket system and lead a team that evened out the workload to be sure all clients received timely response and problem resolution.

This ticket system was able to retain more accounts and increase client customer satisfaction.

Received inbound calls for wireless service in a call center environment. Answer billing questions. Inform customers of new products and services offered. Process change request in a timely manner and provide solutions for outstanding issues. Provide excellent customer service on very call, per quality guidelines.

Practice Account-Based Marketing.

Cold calling, cold emailing, prospecting, and forecasting.

Ran monthly reports to gain awareness of the customers needs and established sales packages based on the report findings.

Developed sales packages and marketing strategies to promote additional sales and revenue.

Att Wireless Cerritos, CA

Business To Business Sales Representative Oct 2003 to April 2007

Received inbound calls in a call center environment for wireless service. Managed Business accounts and Business credit and applications to establish deposit amounts to activate wireless service.

Processed new accounts and order requests.

Promoted sales packages and insurance plans in an effort to generate additional revenue and commission.

EDUCATION

Crenshaw High School, Los Angeles, CA – Diploma

Los Angeles Trade Tech College, Los Angeles, CA – Cosmetology

Professional references available upon request

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