Customer Service Call Center

*******@*****.***

cell: 949-***-****

To acquire a position in a medical call center where I can utilize my superb customer service skills, outstanding communication skills (oral and written) and healthcare industry experience along with my extensive claims knowledge to make an immediate and positive impact for any health care organization.

EDUCATION:

B.A. Economics, University of California, Irvine.

MBA University of Phoenix

SPECIAL SKILLS:

Excellent critical reading comprehension, professional writing skills with the ability to research and confirm information based on existing literature.

Superb ability to absorb new information and process details quickly.

Outstanding telephone demeanor and professional communication skills

Accurately relay pertinent information to others in writing, verbally and by phone

Ability to stay calm under pressure and guide others through high-stress situations

ICD

Experienced in using ZOOM, Cisco Webex, Skype and other video conferencing services.

Understanding of HIPAA mandates and maintaining confidentiality of patients.

Approaches each patient interaction with professionalism, compassion and empathy

Passionate about helping people,out community and our country ...always

Proven track record of solving patient complaints and requests in a professional manner via by email, phone, text, web chat, in person or video teleconferencing.

Energetic self-starter with the ability to manage multiple projects without supervision.

Home Office with ZERO distractions, where no one can see my computer monitor

Advanced working knowledge of MS Office-Word, Excel, Access, Outlook

Excellent math skills, analytical skills, and computer skills.

Excellent presentation skills, organizational skills, problem-solving skills and time management skills

Thorough, prompt and persistent in completing projects and meeting deadlines.

Thrive on working in a busy environment with the ability to multi-task.

PROFESSIONAL EXPERIENCE:

Magellan Health : February 2023 to May 2024

Customer Experience Associate :

Assisted comprehensive support to members regarding their mental health and substance abuse benefits ensuring precise information and resolution in a single interaction

Assisted with resolving all telephone calls from customers and health care providers on inquiries related to claims, eligibility, and authorizations by accurately identifying the needs of the customer and provider and took appropriate action

Documented all incoming calls following HIPAA guidelines in handling patient data

Coordinated with Utilization Review managers /discharge managers to create all level of care authorizations, continuity of care for psychiatric and chemical dependency services as well as concurrent reviews, date extensions etc.Experienced using Avaya, Five 9, Genesys CRM's

Processed claims calls for providers and members for all levels of care (ie denied claims, paid claims, pdr, reprocessed claims et al) always in a professional, efficient timely manner.

Very experienced at using TruCare, TMR, Provider Connection, Iseries

Experienced with regulatory guidelines in managed care (Title 22, AB1455, AB1203, AB1324, AB72, CMS guidelines, COB guidelines, etc.), claims processing, code categories (CPT, ICD 10)

Indiana State Department of Health : June 2020-January 2023

Lead Investigative Specialist: Remote Contact Tracer:

Called contacts of newly diagnosed patients and close contact patients and conducted interviews in a professional manner that reflected cultural and emotional awareness.

Always communicated with positive and closed contacts in a professional, empathetic manner

Collected and recorded information of symptoms into appropriate systems.

Provided contacts with regulated and approved information about local quarantine/isolation procedures, and if appropriate, referred them to testing according to protocol and/or to a COVID-19 social resources.

Collaborated with designated local authorities in supporting the isolation and quarantine of individuals.

Kept strict records of all conversations in our COVID-19 Response Center confidential. and strictly adhered by all HIPAA rules.

Identified customer needs, clarified information, researched pertinent issues, and provided solutions and alternatives to the patients.

Always stayed calm under pressure and guided others through high-stress situations.

Approached each patient interaction with professionalism, compassion and empathy

Compliant with all Health Department regulations including those aimed at protecting personal information.

Followed a script to inform contacts about the importance of quarantine/isolation and what to do if symptoms developed.

Escalated issues to epidemiology lead and maintained daily contact with my managers

Worked closely with a team made up of surveillance coordinators, investigators and data managers to efficiently complete case investigations.

(Enrollment Eligibility Analyst (United Health Care) Santa Ana CA June 2019 to January 2020

Researched errors by comparing enrollment error reports against system information along with with CMS (Center for Medicare and Medicaid Services) records.

Sent correspondence to members or CMS (Center for Medicare and Medicaid Services) to gather information or provide updates for corrections.

Performed basic to advanced clerical functions with proficient PC skills.

Reconciled reports

Worked with analytical and researching techniques to trend or quantify projects

Initiated and assisted with developments / changes to increase or change quality and productivity

Performed basic to advanced clerical functions with proficient PC skills

Worked with various types of member correspondence.

Performed inventory control of member and group transactions.

Prepared, processed, and maintained new member or group enrollments.

Responded to member eligibility or group questions & verified enrollment status.

Business Services of America : Laguna Hills, CA March 2010- May 2018

Customer Service Representative (health care industry call center)

Answered 100 incoming calls daily from patients and acted as a liaison between patient and doctors, medical advisers and other clinic staff in our clinics throughout the nation educating patients on the overall process of our products.

Team supervisor in charge of mentoring, training and advising 10 call center representatives.

Resolved all customer administrative concerns as the first line of contact including all claim resolutions and other expressions of dissatisfaction.

Developed and maintained positive customer relations and coordinated with various functions within the company to ensure customer requests and questions were handled appropriately and in a timely manner.

Scheduled patient appointments for 35 doctor schedules

Processed phone orders with the goal of always upselling patient to a larger treatment program.

Made 40 daily outbound sales calls to try to generate business

Replied to all incoming daily emails from patients answering all of their questions regarding our services, products and medical questions.

Replied to all emails correspondence from doctors, nurses and medical advisors in our 25 clinics.

Processed phone orders, confirmation of patient appointments and next day follow up calls answering patient questions regarding erectile dysfunction and premature ejaculation

Responsible for handling escalated phone calls regarding FEDEX and ONTRAC, UPS complaints.

Handled live conversation via web-chat answering all of patient questions and concerns regarding all of products.

Promoted ICP and Rejuvapulse products to health care providers for contract sales.

Fred L. Piroumian

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