Service Representative Customer
Resume:
Comika Conix
**** ************ ***. ******** ****, Pa. 19076 ·************@******.*** 267-***-****
Highly personable professional with over fifteen years of experience in call-center operations within the healthcare, travel, and home warranty industries. Professional Experience
Health Partners Plans- Philadelphia, Pa. current
Member Relations Representative
•Work remotely to answer inbound calls for medicaid members in a professional and courteous manner.
• Triage the member to insure he or she is being directed to the correct area as well as verifying that all information is current and matches with the Pennsylvania state system.
• Keep current with the knowledge and tools required to provide information and assistance to all inquiries.
Independence Blue Cross – Philadelphia, Pa. 2016 to 2021 Associate Client Service Representative
• Answer inbound calls for providers and members in a professional and courteous manner.
• Determine the nature of the call and take all possible action, including research, completing forms, or any follow up, to expeditiously ensure the provision of accurate information, service and assistance upon first contact.
• Acquire knowledge of all claims systems applications and provider service systems.
• Attain and keep current with the knowledge and skills required to provide information, service and assistance in response to all inquiries.
Aetna – Blue Bell, Pa. 2011 to 2016
Customer Service Representative
• Answer questions and resolves issues based on phone calls from members, providers, and plan sponsors.
•Triage claims resulting a rework to appropriate staff. Document and track contacts with members, providers and plan sponsors.
• Explain member's rights and responsibilities in accordance with contract.
• Determine medical necessity, applicable coverage provisions and verifies member plan eligibility relating to incoming correspondence and internal referral.
• Perform review of member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible. Performs financial data maintenance as necessary.
• Uses applicable system tools and resources to produce quality letters and spreadsheets in response to inquiries received.
Allied Barton Security Services – Philadelphia, Pa. 2008 to 2011 Security Officer
• Check for school identification.
• Take tours around the school facility.
• Protect property by maintaining a high visibility presence to deter illegal and inappropriate actions.
• Report directly to client by logging any issues. Spherion Staffing – Atlanta, Ga. 2007 to 2008
Customer Service Representative
• Answer all of The Coca-Cola Company’s promotion contacts.
• Resolve promotion related issues by educating consumers on the promotion that they are participating in.
• Build or maintain a database of consumer contacts to track, monitor and report consumer issues and trends in order to enable senior management to make informed business decisions. Certified Vacations Group – Fort Lauderdale, Fl. 2006 to 2007 Customer Service Representative
• Assist travel agents and direct customers in booking and revising vacation packages.
• Contact hotels, airlines and other vendors to resolve problems clients are having.
• Process payments and all requests for any type of documents that clients may need. Home Buyers Warranty- Plantation, Fl. 2004 to 2006 Customer Service Representative
• Answer 50 or more incoming calls daily on problems that warranty holders are having in their home.
• Create and dispatch claims to various network contractors.
• Authorize and deny emergency claims that are presented by contractors. Education and Training
Bachelors of Science in Long Term Care Administration 2010 to 2013 University Of Phoenix- Online
Associate of Arts in Healthcare Administration (Medical Records) 2009 to 2010 Axia College of University of Phoenix- online
Certificate of Cosmetology 1996 to 1997
Gordon Phillips Beauty School-Philadelphia, Pa
High School Diploma 1993 to 1996
John Bartram-Philadelphia, Pa
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