Customer Service Specialist
Resume:
MARJEANA L. LIGHTFOOT
S U P P O R T S P E C I A L I S T
C O N T A C T
E D U C A T I O N
P R O F I L E
Proactive, analytical and
solutions-driven Sr. Administrative
and Customer Service Specialist
with over 15 years of experience
in internal and external customer
relations, complaint resolution,
prioritizing and monitoring
workflows. Proven ability to
ensure quality operations and
continuously evaluating and
streamlining work processes to
increase effectiveness and
contribute to overall company
success.
ad5yt9@r.postjobfree.com
References Available Upon Request
E X P E R I E N C E
P R O F E S S I O N A L S K I L L S
Policy and Procedure
Customer Service
Problem Resolution
Proficient in
Microsoft Office
Analyzing Data
Effective Time
Management
HIPAA
Regulations
Retention
Performance
Monitoring
Excellent oral
and written
communication WALMART GBS 2016-2019
Service Agent III
Provided-cross functional support regarding; deliveries, discrepancies, inventory, returns and other merchandise operations related functions
Maintained updated knowledge of all company products and services Provided accurate information about relevant products and services Offered product suggestions to meet client specific needs Fostered and maintained relationships with client and vendors to improve retention rate Researched, processed and resolved electronic invoices from vendors Obtained necessary information from clients to adequately follow up XEROX, LLC 2015-2016
Customer Care Assistant
Managed quality communication, support, and product presentation Guaranteed positive client experiences and resolved issues/complaints Assessed customer needs and offered available products and services Liaison between providers and clients to adjust claims Created new orders in the Lab Inventory Maintenance System (LIMS) Kept abreast of rapidly evolving plan changes and technology Assisted in planning and implementation of department goals Recommended a more effective filing system to accelerate paperwork Strayer University
B.S., Healthcare Administration
August 2020
UNITED HEALTHCARE/WESTMED 2019-2023
Patient Service Representative
Maintained an efficient patient flow through the registration process and provides excellent customer service to patients/families
Processed insurance verifications utilizing the on-line system, and updated the patient account; updates patient information including demographics, insurance, HIPAA forms and financial waivers Effectively communicated problems, concerns, or issues to the Office Supervisor/Manager appropriately and promptly
Scheduled and entered orders for diagnostic tests, and procedures, following all appropriate workflows
Worked cooperatively with Patient Care Resources and clinical staff to ensure timely pre- authorizations
Completed referrals according to departmental guidelines and properly enters into the appropriate system.
Medical Scheduler
Monitored and updated patient scheduling in coordination with physicians Coordinated all appointment schedules with relevant departments Politely greeted each patient professionally and courteously Addressed all patient and client questions, issues and service request Accurately scanned and stored patient insurance documents and medical history records with confidentiality
Fostered and sustained strong professional relationships with staff and clients Jack Welch Management Instiitute
Master of Business Adminstration
December 2023
CIGNA/EVICORE 2023-PRESENT
Patient Service Representative
Communicates with callers from doctors' offices, hospitals, healthcare representatives, members, etc.; professionally delivering high-quality customer service in written, verbal, and electronic communication
Applies comprehensive knowledge of medical terminology to process prior authorization requests for various medical procedures daily
Manages high-quality service in ensuring callers' correct ICD-10 and CPT Codes are proper codes according to coding guidelines and patient diagnosis Responsible for supplying approval and/or denial rationale for prior authorization requests based on clinical guidelines
Collaborates with clinical staff efficiently to further research authorization requests Continually meets performance goals by sustaining average handle call times Maintains confidentiality of patient information, entering personal information in a centralized database; ensuring 100% accuracy of health records
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