Krystal Swoopes

**** ********* ***** ******** ** 75070 · 214-***-****

ad4h1h@r.postjobfree.com

Experienced customer service specialist seeking a role in a dynamic work environment. Ten years of experience working in customer service. Motivated, communicative, and results-driven with excellent problem-solving and organizational skills. Ready to improve customer satisfaction and increase retention levels within a company.

Experience

09/2019 – 08/2021

Customer service representative, Aerotek

●Ensured that all insurance information needed for billing and collections process are accurately obtained and recorded in the computer system (VMWare).

●Contacted patient and/or physician to verify patient has insurance or to update insurance before running a test claim for medications.

●Ensured medical necessity is completed prior to running prescription test claim for intake Prep.

●Communicated with patients about their out-of-pocket payments.

●Initiated the prior authorizations/ pre- determinations for insurance to get verified and processed correctly via cover my meds.

●Followed up with decisions from providers.

●Followed up with doctor’s office about prior authorizations.

●Faxed Letter of medical necessity with clinical notes to provider via cover my meds.

●Effectively research and resolve prescription processing rejections to ensure patients receive medications within established patient standards.

●Corrected errors in various work queues to ensure correct claim filing or refiling of denied claims.

06/16– 07/19

Security guard, all pro security

●Carrying out security checks on visitors, on arrival and exit using security scanners and other equipment

●Performing luggage checks as required

●Keeping a record of all visitors including the time of arrival and departure

●Monitoring surveillance cameras

●Responding to alarms within the premises

●Patrolling the premises regularly to ensure nothing is out of place

●Liaising with law enforcement in the case of suspected or reported criminal activity

●Performing scheduled and random checks of designated areas throughout the facility to check for any security breaches

●Assisting the maintenance staff in securing an area during a maintenance emergency

09/14 – 03/16

Driver, Ups

●Making deliveries as quickly and efficiently as possible.

●Operating the vehicle in a safe and responsible manner at all times.

●Following company identification standards.

●Assisting with loading and unloading the truck.

●Keeping logs up to date and ensuring valid information is recorded.

07/2012 – 05/2014

Customer Care Advocate, Connextions

●Assisted members by answering their questions when they would call in to inquire about services covered by their insurance plan.

●Direct phone-based customer interaction to answer and resolve a wide variety of inquiries, questions related to pharmacy benefits, mail order and pharmacy assistance.

●Worked various shifts and overtime hours to accommodate the needs of the company.

●Manage a wide variety of customer service and administrative tasks to resolve customer issues quickly and effectively.

●Locating in-network physicians, hospitals and urgent care facilities for the members.

●Check to ensure that appropriate changes were made to resolve customers' problems.

●Update account information such as billing options and changes of address or phone numbers.

●Follow up with provider to provide resolution to telephone inquiries not resolved as first contact call.

Education

June 2006

High school Diploma, Hillcrest Highschool

Skills

●Critical Thinking

●Verbal and Written Communication

●Healthcare

●People skills

●Adaptability

●Problem-solving

●Microsoft

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