Customer Service Representative

TIFFANY L DOUGLAS

**.*********@*****.*** 323-***-**** 5101 E. Twain Avenue Las Vegas, NV 89122

SUMMARY

Committed job seeker with a history of meeting company needs. Skilled in working under pressure, multitasking, and adapting to new challenges and changes. Highly skilled in organization and being knowledgeable about company product/business to not only work for, but to be a part of your company.

SKILLS

●Verbal and Written Communication

●Processing CMS-1500 and UB04 Claim Forms

●Efficient and Detail-Oriented

●Multitasking and Prioritizing

●Data Entry

●40wpm Typing Speed

●MS Office

●Policies and Procedure Adherence

●Proactive Self-Starter

●Order and Refund processing

●Taking Inbound/Making Outbound calls

●Courteous with strong Customer Service

●Customer Account Management

●Complaint Resolution

●Excellent Attention to Detail

●Customer Data Confidentiality

●Teamwork and Collaboration

●Document and Records Management

EXPERIENCE

SITEL – USAA CONTRACT – Las Vegas, NV – Member Service Representative - 10/2021 - Current

●Answer member questions about existing accounts

●Process Balance Transfers

●Process and Submit Internal and External Cash Advances

●Navigate internal systems to assist members

●Provide excellent service during each interaction to enhance customer relationships

●Update/Add new and modified member data

●Assist member with paying Credit Card Bills

●Send requested documents to member

●Access internal knowledgebase to manage customer conflicts and challenging situations

●Adherence to metrics and compliance

ANTHEM INC – Las Vegas, NV - Customer Service Representative – 10/2020-05/2021

●Take inbound calls for Medicare Advantage Plan

●Document Member and Provider inquiries

●Verify coverage and benefits

●Verify Claim Status for Member and Provider

●Verify Authorizations for Member and Provider

●Call Providers for Verification

●Send Correspondence per Member request

●Send Secure Emails

CVS/CAREMARK INGENIORX - Las Vegas, NV - Customer Care Representative – 07/2019-06/2020

●Take inbound calls (Commercial, Medicaid, Medicare, Public Exchange)

●Answer Prescription Benefit Plan questions

●Verify Coverage Determinations

●Process Plan Benefit Overrides

●Submit Appeals for denied Prior Authorizations

●Use Source/CIF to provide accurate plan information

●Verify Prior Authorizations for Members and Providers

●Call Specialty Pharmacy to Verify/Update Claims Processing Information

●Process Test Claims for Members

C3 CUSTOMER CONTACT CHANNELS – Las Vegas, NV – Floor Supervisor – 11/2016-06/2019

●Established and enforced clear goals

●Monitored employee productivity to provide feedback and coaching

●Coordinated employee schedules according to shifts changes and availability

●Maintained positive work relationships with fellow staff and management

●Complied with company objectives, policies, and communication goals

●Planned and Lead Team Meetings

●Identified and corrected performance and personal issues

MOLINA HEALTHCARE – Long Beach, CA – Sr. Enrollment Representative – 04/2016-10/2016

●Respond to request for information about Health Plan Enrollment process

●Proofread enrollment documents carefully to check accuracy and completeness

●Comply with HIPAA regulations

●Maintained Confidential Patient documentation to prevent data compromise

●Understood and followed oral and written directions

●Worked successfully with a diverse group of co-workers as a team

●Prioritized and organized task to efficiently to accomplish service goals

●Called providers to verify or update claim information

EDUCATION

GEORGE WASHINGTON PREPARATORY HIGH SCHOOL

Los Angeles, CA – High School Diploma – 09/1989-06/1990

Contact this candidate