Customer Service Representative
Resume:
Professional summary
Experienced Customer Service Representative with 5 years of expertise in insurance policy review and customer service. Adept at utilizing EMR systems, understanding medical terminology, and employing effective communication to resolve complex issues and enhance client satisfaction. Proven ability in fraud prevention and efficient caseload management, seeking to contribute these skills in a progressive team environment. Employment history
UnitedHealth Group Complex Customer Service Rep Remote Feb 2023 - Present
Crawford & Company - Citizens Property Insurance Claims Adjuster Atlanta, Georgia Feb 2022 - Feb 2023
IBM Corporation Healthcare Verification Specialist Atlanta, Georgia Jun 2022 - Dec 2022
Shaquita Benson
21359 Cypress Conifer Dr., Cypress, 77433
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Communicate effectively with customers, resolving complex medical claims and discrepancies. Review medical benefits and initiate prior authorization requests, ensuring timely updates. Order member ID cards and connect members with Registered Nurses for clinical needs. Collaborate on departmental projects, contributing to overall success. Improve customer satisfaction by coordinating with medical professionals and administrative staff. Supported members in navigating healthcare plans and benefits, leading to better understanding and utilization of available services.
Reviewed policy details using Xactianalysis, ensuring accurate claim assessments Assessed property damage through GIC and photos, providing precise evaluations Communicated policy limits and claim processes to clients, enhancing understanding Detected insurance fraud, recommending suspicious claims for further investigation Estimated damages with Xactimate, creating detailed sketches and line items Collaborated with adjusters and contractors to expedite claim resolutions, reducing processing time by 20%. Reviewed insurance plans to determine prescription coverage, ensuring accurate patient information. Verified pharmacy and medical benefits via phone, facilitating smooth communication with PBMs. Explained prescription coverage, copay assistance, and pre-authorization processes to policyholders. Collaborated with health insurance plans to update prescription changes and address claim rejections. Updated patient demographic data, enhancing the accuracy of records and improving service delivery. Partnered with healthcare providers to resolve complex prescription issues, enhancing patient satisfaction. Grady Memorial Hospital Emergency Room Revenue Cycle Representative Atlanta, GA Apr 2019 - Sep 2021
Emory University Hospital- Midtown Revenue Cycle Representative Atlanta, Georgia Sep 2019 - Jul 2021
Education
Associate of Applied Science in Nursing Kishwaukee College Malta, IL Sep 2008 - May 2010
B.A. in Psychology Georgia State University Atlanta, GA Sep 2018 - May 2020
Certifications
GA/TX Claim Adjuster License
Feb 2022
GA Real Estate Salesperson License
Jun 2022
Skills
Effective Communication Caseload Management
EMR Proficiency Medical Terminology
Insurance Policy Review Conflict Resolution
Data entry Sales
Processed co-payments and out-of-pocket expenses using EHR (Epic), ensuring accurate financial records. Verified patient insurance eligibility and facilitated benefit access, improving patient satisfaction. Performed data entry using electronic medical records and medical terminology, ensuring data accuracy. Assessed financial needs, directing patients to assistance programs, enhancing financial support access. Managed patient scheduling, confirmations, and cancellations, handling over 100 calls daily. Collected copayments and checked in ER patients, enhancing workflow and patient satisfaction. Ensured accurate and timely financial transactions in the ER, improving financial accuracy. Collaborated with medical teams to verify patient data, maintaining compliance with healthcare regulations. Processed co-payments and out-of-pocket expenses using EHR (Epic), ensuring efficient billing operations. Coordinated with insurance providers to ensure accurate patient billing, improving claim approval rates. Proactively addressed patient inquiries and concerns, contributing to a welcoming and supportive ER environment.
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