Customer Service Quality Review
Resume:
QUALITY REVIEW AND AUDIT LEAD REPRESENTATIVE — Cigna Medicare
Phoenix, Arizona, September 2022 - Present
CUSTOMER SERVICE SENIOR REPRESENTATIVE — Cigna Medicare Phoenix, Arizona, September 2018 - September 2022
LISA WALKER
Phone 805-***-****
Email ********@*******.***
Address Watsonville, CA 95076
• Bilingual Spanish • Client Relationship Management
• Efficiency Optimization • Process Evaluations
• Compliance Monitoring • Microsoft Suite
• Google Suite
Review outbound customer calls for accuracy and quality supporting the department's overall goals to increase retention.
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Manage quality review activity and meet all key deliverables, including turnaround times, communicate and document corrections, and provide actionable feedback.
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• Document findings in appropriate Cigna quality repository ensuring documentation is clear and concise.
• Coach individuals to improve performance.
Develop and distribute audit reviews and trend reports. Identify and recommend improvements in department processes and procedures and partner with trainers to refine quality guidelines.
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Partner with leadership and project managers to refine and restructure the call quality review process, including prioritizing top-tier customer experience while following legal and compliance guidelines
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Act as a subject matter expert and resource for team members for the quality process. Actively engage in quality initiatives to address error trends and process improvement.
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• Contribute to the execution of process improvements/changes. Conduct outbound calls to customers for retention initiatives, welcome campaigns, and other engagement efforts, ensuring a positive customer experience.
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• Perform thorough research on benefits, providers, and customer inquiries to provide accurate and timely assistance. Act as a customer advocate by collaborating with various departments to address customer concerns and enhance service delivery.
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Accurately document customer interactions in call tracking systems, ensuring all information is recorded systematically for future reference.
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Serve as an advocate for customers navigating Medicare and Medicaid processes, facilitating access to necessary resources and support.
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SKILLS
EXPERIENCE
ONE GUIDE AND DEDICATED ACCOUNT CUSTOMER SERVICE REPRESENTATIVE — Cigna Medicare Phoenix, Arizona, July 2017 - August 2018
PATIENT SERVICES COORDINATOR — Dr. Barry Silberg, C.S Monterey, California, July 2015 - June 2017
MEDICAL ASSISTANT — Geriatric Medical Group
Monterey, CA, July 2013 - July 2015
Proficiently navigate multiple computer systems, including Microsoft Office, claims systems, and call recording software
(QNXT, CKIT, Finesse, OMD, CCMS), to research and document customer data effectively.
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Perform ad-hoc customer-related duties as needed, demonstrating adaptability to meet evolving customer needs and departmental objectives.
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• FedEx Dedicated Account
• Respond to complex customer inquires regarding benefits, billing, eligibility and coverage
• Provide solutions to customer questions about One Guide product offerings
• Assist customers in addressing concerns related to coverages
• M.D., F.A, Opening and closing the office daily in accordance with procedure
• Scheduling of patient appointments and surgery scheduling
• Schedule nurse and anesthesiologist for in-house surgical procedures
• Meet and greet patients, vendors and business people who contact the office
• Maintain marketing results list
• Maintain new patient consults list
• Enforce HIPAA guidelines when working with patients and vendors Meet with patients in advance of scheduled surgery to review pre and postoperative instructions and collect payment for procedures
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• Prepare deposits for courier pickups
• Acquire authorization from insurance companies
• Records management
• Product sales and inventory tracking of products
• Prepare patient quotes for services requested
• Perform patient in-take procedures to include vital signs and medical history
• Administer injections
• Perform EKG and Spirometry tests
• Prepare lab orders
• Submit all office referrals and prior authorizations
• Refill medications
• Perform various front office functions
• Maintain exam rooms
• Collect co-pays
• Insurance verification
MEDICAL ASSISTANT — Progressive Urology
La Porte, IN, January 2012 - June 2013
CUSTOMER SERVICE — Medical Call Management
Oxnard, CA, May 2011 - December 2011
CUSTOMER SERVICE REP — Lincare, INC
Moorpark, CA, November 2010 - April 2011
MEDICAL ASSISTANT — Office Works R
Oxnard, CA, January 2008 - January 2009
MEDICAL ASSISTANT — Dr. Irene Wakam
Ventura, CA, June 2007 - October 2007
• Perform office deposits
• Answer multiple phone lines
• Make appointments
• Confirm appointments
• Maintain electronic health records
• Perform patient in-take procedures to include vital signs and injections
• Assist with minor procedures to include set-up
• Maintained examination rooms; re-stocked as needed
• Catheter and staple removal
• Process medication requests
• Answer multiple phone lines and make patient appointments
• Prepare patient charts and lab reports
• Answered multiple phone lines
• Data Entry
• Marketing
Receiving and organizing incoming data including physician orders, patient history notes, testing, and equipment qualifications
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• Insurance verification
• Billing
• Cover multiple phone lines
• Prepare various monthly reports
• Order intake and processing
• Dispatching various tasks to service technicians
• Prepared charts in the Workers Compensation Orthopedic Office
• Handled all legal subpoenas
• Provided work status to employers and insurance companies
• Patient check-in and sent out all mailings to include claims MEDICAL UNDERWRITER — WellPoint/Blue Cross of California Newbury Park, CA, March 2003 - February 2007
CUSTOMER SERVICE — WellPoint/Blue Cross of California Newbury Park, CA, September 2001 - March 2003
HOME HEALTH AIDE — VNA
Livingston, Ventura, CA, September 1993 - October 2001 MEDICAL ASSISTANT/WARD CLERK — Buenaventura Medical Clinic Oxnard, CA, October 1998 - September 2001
HIGH SCHOOL DIPLOMA
— Upland HS
Upland CA,
• Performed patient in-take procedures to include vital signs, injections and EKGs
• Assisted with minor procedures to include set-up
• Maintained examination rooms; re-stocked as needed
• Ordered all supplies and injectables
• Submitted referrals to IPA as well as prior authorizations on medications to assigned insurance companies
• Assisted receptionist with answering phones and scheduling appointments
• Reviewed individual insurance applications and medical records to determine eligibility
• Rated plan or declination of medical insurance
• Extensive knowledge of HMO, PPO, IPA and medical groups
• Assisted members with various eligibility issues
• Provided members answers to their coverage questions
• Extensive knowledge in various types of insurance policies
• On-call position primarily involving patient care and various health aide related duties
• Performed patient in-take procedures to include vital signs, injections and EKGs
• Assisted with minor procedures to include set-up
• Maintained examination rooms; re-stocked as needed
• Ordered all supplies and injectables
• Submitted referrals to IPA as well as prior authorizations on medications to assigned insurance companies
• Verified eligibility of insurance (HMO & PPO)
• Prepared laboratory orders; maintained log of results
• Sterilized instruments
EDUCATION
REFERENCES
References available upon request
Contact this candidate