Customer Service Associate

Monique Benford

Detroit, MI *****

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

313-***-****

A driven, customer-centric professional with 20+ years of customer service experience working in various industries who is: analytical, highly motivated, goal oriented, self-managed, and a dedicated learner that is seeking a position where excellent analytical, planning, attention to detail oriented, communication, time management, comprehension, and patience that will be utilized within a secure, professional, and diverse environment.

· Extensive: analytical, research, communication, attention to detail, and time management skills.

· Excellent: writing, spelling, grammar, punctuation, and proofreading skills.

· Systems: Microsoft Office Suite (Word, Excel, Outlook, Teams) Salesforce, QuickBooks/ QuickBooks Online

Work Experience

Claims Process Center Service Associate II

ALLSTATE

January 2022 to Present

· Communicate compassionately with customers and help them through their claim process in a fast and easy manner while maintaining confidentiality.

· Provide timely follow-up with both internal and external entities.

· Analyze customer concerns and utilize multiple systems and databases to provide resolution for concerns and communicate information in understandable terms to the Insured/Claimant/Third Party Carrier.

· Review arbitration decisions and claim documentation and notes in claim in accordance with business unit standard methodologies to route file to appropriate party.

· Upload pertinent documentation to compile subrogation demands, remove unnecessary pages, quality check demand before securely uploading and sending to third party carriers for review and response.

· Respond promptly to adjusters, customers, claimants, and third-party carriers to move claims forward.

· Create, verify, index, and upload documents, utilizing Microsoft Word Suite, Adobe Acrobat, and others software.

· clerical duties that included: data entry, paperwork filing, and other support functions.

· Problem solving and contributing to team goals by sharing ideas and opinions. Remote Customer Service Representative

INFINITE COMPUTER SOLUTIONS - IBM & NY DOL

May 2021 to October 2021

· Answered inbound calls from NY DOL claimants that filed for Pandemic Unemployment Assistance.

· Exhibited professionalism and a cheerful outlook with claimants who may be under stress or frustration.

· Answered questions and verified information utilizing various online databases.

· Oversaw confidential information with discretion.

· Analyzed issues related to claims and provided decisions and next steps.

· Escalated issues to appropriate personnel for next level assistance.

· Composed and mailed appropriate correspondence related to appropriate DOL issue.

· Basic proficiency with computers and smart phones to work remotely.

· Navigated various web-based applications, mainframes, and other user interfaces.

· Communicated with Squad Lead and Team via Slack and Webex. Customer Service/Sales/Administrative Assistant

MDB STAFFING

May 2019 to May 2021

· Coordinated, facilitated, and conducted interviews via video conference.

· Work from home with ability to work various inbound and outbound Agencies on a contractual basis.

· Managed high volume of inbound activities for a multitude of business partners via phone and chat using a script.

· Placed outbound sales calls to set appointments for sales force for several companies, utilizing a script.

· Documented detailed steps and actions taken for each call answered and placed in each business partner’s selected CSI screens.

· Process orders and payments, relay messages in proper format, and function as liaison for Client.

· Ability to use multiple software applications and databases via multiple screens and browser tabs.

· Display a positive attitude, organizational skills, and perform well under pressure in a remote environment.

· Remained engaged by listening with empathy, communicating effectively, and capturing accurate information.

· Utilized Ryver, Skype, Slack, and Google for communication with team members, Team Leads, and Administration.

· Worked independently for extended periods of time, free of external interruptions in home-based office.

· Ability to adapt to changes in policies and procedures and implement them immediately to provide accurate information.

· Flexibility to work in a variety of environments - independently, within a team, face-to-face, and virtually. Contact Service Representative

SOCIAL SECURITY ADMINISTRATION

June 2019 to December 2020

· Assisted the public by answering a wide variety of questions via telephone in a busy call center and remotely.

· Conducted interviews, investigated situations, and resolved complex and non-complex issues.

· Assessed relevant information to determine ongoing eligibility for Social Security benefits.

· Scheduled field office appointments for SSA claimants to establish SSA benefits.

· Analyzed a claimant’s benefit payment history to answer billing questions.

· Worked with the public by telephone or mail regarding benefits and payment amounts for various Social Security programs.

· Solved problems through use of Social Security policies and regulations utilizing multiple online resources.

· Provided basic technical support with regards to SSA online accounts.

· Requested and mailed SSA literature and correspondence that may provide pertinent information regarding case.

Unemployment Insurance Examiner 10

STATE OF MICHIGAN DLEG

December 2005 to September 2018

· Interviewed claimants, employers, and/or other interested parties via telephone, mail, fax, and in person to determine eligibility for unemployment benefits and/or resolve unemployment claim(s) issues.

· Contacted claimants, employers, and other interested parties to obtain necessary information relative to contested/questionable unemployment claims and protests.

· Processed new, additional, reopened, and continued unemployment claims as well as appeals and protests.

· Weighed, reviewed, resolved, and issued monetary and non-monetary

(re)determinations and reconsideration, administrative errors, and restitution determinations based on state law and procedures.

· Established and maintained restitution accounts and performed collection activities.

· Applied monetary and non-monetary decisions based on Office of Appeals, Board of Review, or court rulings.

· Ability to work in a team setting with little to no supervision.

· Met and exceeded Departmental Metrics

Provider Resolution Specialist

UNITEDHEALTHCARE INC.

June 2017 to February 2018

· Reviewed and researched project or more complicated claims by navigating multiple computer systems and platforms and accurately capturing the data/information necessary for processing (e.g., verify pricing, prior authorizations, applicable benefits, coding).

· Updated claim information based on research and communication from member or provider.

· Executed necessary adjustments to claims and ensured the proper benefits were applied to each claim by using the appropriate processes and procedures (e.g., claims processing policies and procedures, grievance procedures, state mandates,

CMS/Medicare guidelines, benefit plan documents/certificates).

· Completed daily all data entry required to document and communicates the status of claims as needed adhering to all reporting requirements.

· Communicated extensively with members and providers regarding adjustments to resolve claims errors/ issues, using clear, simple language to ensure understanding.

· Learned and leveraged new systems and training resources to help apply claims processes/procedures appropriately (e.g., on-line training classes, coaches/mentors).

· Meet the performance goals established for the position in the areas of efficiency, accuracy, quality, member satisfaction and attendance.

Customer Service II (Temporary)

BLUE CROSS BLUE SHIELD OF MICHIGAN/BLUE CARE NETWORK December 2016 to May 2017

· Analyzed, evaluated, resolved, and responded to customer/provider inquiries received via telephone.

· Provided accurate information involving a variety of claim/benefit issues under various product lines.

· Conducted internal and external research to determine and request the data needed to manage inquiries from Subscribers, Beneficiaries, Accounts or Providers.

· Processed payments, calculated past due amounts, provided payment timeliness as it pertains to coverage.

· Obtained needed external data. Analyzes and services various product lines in the area (i.e., Administrative, Facility, Professional, Special Programs

(Medicare/Complementary).

· Documented phone conversation thoroughly within the Members file.

· Executed multiple tasks simultaneously, while effectively managing time.

· Provided servicing responses by placing an outbound telephone call, handwritten/check-off letters, or by a typewritten, self-composed letter.

· Performed repetitive manual dexterity while performing computer data entry.

· Worked overtime when asked to clear phone queue and assist with written communications, and internet requests.

· Transferred misrouted phone calls utilizing the proper transfer protocol.

· Completed and learned any additional task requested. Education

Bachelor of Science in Business Administration

University of Phoenix - Phoenix, AZ

Skills

• analytical

• research

• communication

• attention to detail

• time management skills.

• writing

• spelling

• grammar

• punctuation

• proofreading skills.

• Microsoft Office Suite (Word, Excel, Outlook, Teams) Salesforce

• QuickBooks/ QuickBooks Online

Contact this candidate