Customer Service Representative
Resume:
KHAHAYLA
HAYMAN
*********@*****.***
Florence, SC 29501
Diligent Claims Processor versed in insurance processes and claims procedures. Offers great attention to detail and time management abilities to successfully handle large volume of claims. Highly accurate and thorough with focus on completing error-free work in line with processing guidelines. Passionate about promoting lasting customer satisfaction by delivering quality service and unparalleled support. Proficient in customer service best practices and related options. Customer Service Representative bringing top-notch skills in oral and written communication, active listening and analytical problem-solving skills. Enhances customer experiences by employing service-oriented behaviors, understanding customer desires, ad providing customized solutions to build loyalty.
PROFESSIONAL SUMMARY
SYKES - Claims Processor
Remote • 01/2019 - Current
WORK HISTORY
Utilized specialized software to process incoming claims, enter data and generate reports.
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Complied with regulations and guidelines related to claims processing to maintain quality and adherence to standards.
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Assisted in onboarding of new claims processors to familiarize with company procedures, policies and processes.
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Utilized excellent analytical and problem-solving skills to quickly and accurately assess insurance claims.
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Reviewed applications and supporting documents to verify claims eligibility and accuracy.
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• Followed up with customers on unresolved issues. Managed workload and priorities to meet claims processing meet deadlines.
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Developed and implemented quality assurance processes to check accuracy of claims processing.
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Monitored claims processing trends to identify potential areas of improvement.
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Responded to customer inquiries, providing detailed explanations of insurance policies and claims processes.
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Established positive and trusting relationships with injured clients, administering efficient customer service and processing claims quickly.
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Collaborated with claims department and industry anti-fraud organizations to resolve claims.
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Identified and reported potential fraud or abuse related to claims to protect system's integrity.
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Evaluated accuracy and quality of data entered into agency management system.
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Carried out administrative tasks by communicating with clients, distributing mail, and scanning documents.
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• Verified client information by analyzing existing evidence on file. Prepared insurance claim forms or related documents and reviewed for completeness.
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SKILLS
• Validation of Discrepancies
• Financial Assistance
• Office Operations
• Payments Posting
• Transactions Reconciliation
• Informational Releases
Accounts Payable and Accounts
Receivable
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• Past Due Balance Management
• Information Updates
• Customer Feedback
• Legal Standards
• Insurance Terminology
• Insurance Plan Verification
• Office Supplies and Inventory
• Microsoft Office
• Regulatory Compliance
• Customer Retention
• Constructive Feedback
• Reading Comprehension
• Office Organization
• Training Junior Team Members
• Project Requirements
• Client Correspondence
• Client Rapport-Building
• Digital Filing
• Data Communications
• Status Updates
• Account Management Software
• Professional Development
Customer Relationship
Management
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• Patient Admission
• Cold Calling
• Business Development
Understanding
• Account Management
• Microsoft Excel
• Retail Sales Customer Service
• Lotus Notes
• Microsoft Word
• Report Creation
• Stocking and Replenishing
• Senior Leadership Support
• Customer Relations
• Report Transcription
• Credit Card Payment Processing
• Fleet Dispatching
• Stock Management
• Project Management Abilities
• Microsoft PowerPoint
• Active Listening
• Staff Training
• Order Fulfillment
• Receiving Support
• Travel Planning
• Promotional Support
• Medical Terminology Knowledge
• Product Organization
• Closing Sales
• System Implementation
• Route Dispatch
• Documentation Research
• Data Quality
• Data Entry Software
University of Phoenix
Tempe, AZ
Business Management
Strayer University
Washington, DC
Bachelor Of Accountancy
EDUCATION
Walmart - Customer Service Representative
Florence Sc • 12/2015 - 11/2019
Maintained confidentiality of patient finances, records, and health statuses.
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Maintained strong knowledge of basic medical terminology to better understand services and procedures.
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Checked documentation for accuracy and validity on updated systems.
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Tracked and reported on claims processing metrics to aid senior management in making informed decisions.
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Communicated effectively with staff members of operations, finance and clinical departments.
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Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
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• Generated, posted and attached information to claim files. Reviewed outstanding requests and redirected workloads to complete projects on time.
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• Processed and recorded new policies and claims.
• Calculated adjustments, premiums and refunds.
Determined appropriateness of payers to protect organization and minimize risk.
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• Posted payments to accounts and maintained records.
• Modified, updated and processed existing policies. Made contact with insurance carriers to discuss policies and individual patient benefits.
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Assured timely verification of insurance benefits prior to patient procedures or appointments.
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Notified insurance agents and accounting departments of policy cancellations and changes.
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• Coordinated with contracting department to resolve payer issues.
• Collected premiums and issued accurate receipts. Handled customer inquiries and suggestions courteously and professionally.
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Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
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• Answered constant flow of customer calls with minimal wait times. Answered customer telephone calls promptly to avoid on-hold wait times.
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Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
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• Updated account information to maintain customer records. Offered advice and assistance to customers, paying attention to special needs or wants.
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Responded to customer requests for products, services, and company information.
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Clarified customer issues and determined root cause of problems to resolve product or service complaints.
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Processed customer service orders promptly to increase customer satisfaction.
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Participated in team meetings and training sessions to stay informed about product updates and changes.
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Provided primary customer support to internal and external customers.
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Developed customer service policies and procedures to meet and exceed industry service standards.
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Dollar Tree - Department Head Manager
Florence Sc • 02/2013 - 11/2015
Tracked customer service cases and updated service software with customer information.
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Utilized customer service software to manage interactions and track customer satisfaction.
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Analyzed customer service trends to discover areas of opportunity and provide feedback to management.
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Delivered exceptional customer service to every customer by leveraging extensive knowledge of products and services and creating welcoming, positive experiences.
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• Investigated and resolved customer inquiries and complaints quickly. Exhibited high energy and professionalism when dealing with clients and staff.
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Responded to customer requests, offering excellent support and tailored recommendations to address needs.
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Met customer call guidelines for service levels, handle time and productivity.
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• Delivered prompt service to prioritize customer needs. Educated customers about billing, payment processing and support policies and procedures.
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Followed up with customers about resolved issues to maintain high standards of customer service.
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• Responded proactively and positively to rapid change. Promoted superior experience by addressing customer concerns, demonstrating empathy, and resolving problems swiftly.
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Provided excellent customer care by responding to requests, assisting with product selection and handling ordering functions.
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Developed highly empathetic client relationships and earned reputation for exceeding service standard goals.
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Collaborated with staff members to enhance customer service experience and exceed team goals through effective client satisfaction rates.
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Promptly responded to inquiries and requests from prospective customers.
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Calculated correct order totals, updated accounts, and maintained detailed records for inventory management.
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Managed timely and effective replacement of damaged or missing products.
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• Developed and updated databases to handle customer data. Monitored cash drawers in multiple checkout stations and maintained adequate cash supply.
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Enhanced productivity levels by anticipating needs and delivering outstanding support.
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Cross-trained and provided backup support for organizational leadership.
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• Trained staff on operating procedures and company services.
• Investigated and resolved accounting, service and delivery concerns. Maintained clean and orderly checkout areas by mopping floors, emptying trash cans and wiping down surfaces.
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Collaborated with sales team members to stay current on inventory levels, complete accurate orders, and resolve item issues.
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Reached out to customers after completed sales to suggest additional service or product purchases.
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• Managed inventory and receiving operations to maintain optimal stock levels and meet expected demands.
Communicated with managers of other departments to maintain transparency.
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Created and enforced department policies, procedures and standards to establish productivity and quality.
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Kept employee workloads fair and balanced to achieve objectives while maintaining high job satisfaction.
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Motivated associates to consistently deliver effective selling behaviors through coaching and recognition.
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Worked actively with management team to create daily and weekly sales plans based on weekly sales trends.
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Partnered with merchandising team to plan and execute floor moves, merchandise placement, and overall sales set-up.
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Introduced new methods, practices, and systems to reduce turnaround time.
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Developed and implemented useful inventory management strategies to maximize sales and reduce costs.
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Reduced process bottlenecks by training and coaching employees on practices, procedures, and performance strategies.
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Implemented process improvement to shape organizational culture, optimize procedures for higher efficiency and help company evolve and grow.
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Prepared detailed reports for management to clarify existing trends, review sales and inventory data and support shrink minimization and safety awareness.
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Developed and managed department budget to monitor financial performance and minimize expenses.
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• Prepared annual budgets with controls to prevent overages. Performed statistical analyses to gather data for operational and forecast team needs.
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Maintained positive customer relations by addressing problems head-on and implementing successful corrective actions.
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Maintained professional demeanor by staying calm when addressing unhappy or angry customers.
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Opened and closed location and monitored shift changes to uphold successful operations strategies and maximize business success.
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Established team priorities, maintained schedules and monitored performance.
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Evaluated employee performance and conveyed constructive feedback to improve skills.
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Assisted in organizing and overseeing assignments to drive operational excellence.
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Used industry expertise, customer service skills and analytical nature to resolve customer concerns and promote loyalty.
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Defined clear targets and objectives and communicated to other team members.
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Recruited, interviewed and hired employees and implemented mentoring program to promote positive feedback and engagement.
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Cultivated positive rapport with fellow employees to boost company morale and promote employee retention.
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Trained personnel in equipment maintenance and enforced participation in exercises focused on developing key skills.
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Established performance goals for employees and provided feedback on methods for reaching those milestones.
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Improved staffing during busy periods by creating employee schedules and monitoring call-outs.
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Successfully managed budgets and allocated resources to maximize productivity and profitability.
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• Developed detailed plans based on broad guidance and direction. Set aggressive targets for employees to drive company success and strengthen motivation.
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Identified and communicated customer needs to supply chain capacity and quality teams.
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Planned, created, tested and deployed system life cycle methodology to produce high quality systems to meet and exceed customer expectations.
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Managed senior-level personnel working in marketing and sales capacities.
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Streamlined and monitored quality programs to alleviate overdue compliance activities.
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