Janice Curtis

****A Wedgewood Place

Waldorf, MD. 20602

adblnd@r.postjobfree.com

240-***-****

Call Center Representative

•Strong Communication skills over the phone and face to face.

•10 plus years of healthcare insurance customer service and call center experience to include Medicaid (District of Columbia & Maryland) MCOs, HMOs, PPOs and other private insurance platforms.

•Demonstrated analytical and problem-solving ability.

•Demonstrated customer focused service.

Experience:

CareFirst/FEPOC BlueCross BlueShield

Washington, DC 09/2019 to 01/17/2020

Contact Center Agent -Temporary

Responsible for answering a high volume of phone calls and inquiries from Federal Government agencies regarding the Federal Employees Health Benefits Program. Duties include updating subscribers, their dependents and retirees’ health insurance contracts by accurately entering data provided by electronic and paper submissions. Responsible for resolving enrollment errors in accordance to Federal Government standard operating procedures.

GW Medical Faculty Associates

Arlington, VA 02/2019 to 06/30/2019

Call Center Representative/Scheduler

Responsible for scheduling and registering Medical Faculty Associates, Inc. patients while providing excellent customer service to all callers. Duties include performing all registration for new patients and updates registration information for established patients. Duties also included performing all aspects of scheduling, canceling, and rescheduling appointments based on type of appointment guidelines established by department and providing patient instructions verbally or in writing when necessary for patient to prepare for appointment. Worked with administrative assistants and other internal departments directing calls to the managerial team when necessary.

Efficiently resolved customer needs and processed requests submitted by clinical staff and team members in all applicable systems.

AmeriHealth Caritas DC. Medicaid MCO

Washington, DC. 07/2018 – 10/2018

Member Services Representative - Temporary

Responsible for supporting the daily operations of integrated care management program interventions. Performed in a contact center environment processing calls from Members, Providers and other areas, internal and external to the company. Maintained current knowledge of member services policies and procedures. Identified members with Care

Gaps/HEDIS related health conditions and assisted them in accessing care through Plan benefits and community resources. Under the direction of Clinical staff, provided members with educational materials and carry out strategies to increase health care adherence and reduce barriers to care.

MedStar Family Choice DC Medicaid MCO

Washington, DC. 06/2015 - 11/2017

Customer Service Representative

Responsible for answering a high volume of inbound calls received via an automated call distribution (ACD) line in a fast-paced call/contact center environment. Duties included communicating with members and providers to confirm the status of prior authorizations and provider network updates. Answered questions and provided information and education on programs and services. Conducted insurance verifications and assisted members with MCO enrollments and PCP selections. Worked with Caremark Pharmacy to provide first call resolution to pharmacy related issues. Submitted referrals from clinicians for members to participate in Case Management Programs. Provided support services to the Credentialing Department, Compliance Department, Clinical Case Managers, Social Workers and Medical Director. Processed email, fax and mail requests for prior authorizations or forwarded them to other departments when appropriate. Duties also include pulling authorization requests from the Streem Fax platform and creating profiles in CCMS/Identify database. Utilized Care Management Platform to accurately document all incoming calls associated with members, including the creation of notes and actionable tasks for care management and care navigation teams.

DGA, Inc.

Ellicott City, MD. 01/2015 - 06/2015

Customer Services Representative

Responsible for answering service calls within a call center to address client needs, complaints, or other issues with products or services. Scheduled service appointments for automobile maintenance and repair. Engaged in active listening with callers confirming or clarifying information and diffusing angry clients by explaining possible solutions. Made customer service follow-up calls to ensure clients felt supported and valued. Completed client satisfaction surveys for dealerships and engaged in ongoing research of current product recalls and knowledge of company products that could be offered to optimize customer satisfaction.

CareFirst BlueCross/BlueShield

Washington, DC. 08/2001 - 01/2006

Customer Service Representative

Handled high volume of inquiries from members and providers received via an automated call distribution (ACD) line within a call center. Responded to written correspondence utilizing current reference materials and available resources. Responsible for documentation of all activities for quality and metrics reporting through the Customer Relationship Management (CRM) application. Provided uniform interpretation of benefits to members and providers. Conducted insurance verifications. Reviewed benefit and eligibility information that included medical, prescription drug and dental benefits. Calculated deductibles, coinsurances and out of pocket expensed. Educated members on plan exclusions, referrals, pre-certification or pre-authorization requirements. Consistently met quality assurance metrics. Maintained best practices and policies.

Shannon and Luchs Insurance Agency

Washington, DC. 09/1998 - 04/2001

Administrative Assistant

Provided administrative support for group administrators and small business owners by processing new and renewal applications for group health and life insurance. Processed new business and renewal applications. Screened documents and contacted group administrators to obtain missing or incomplete information. Submitted new business and renewal applications to carriers to ensure timely filing and followed up with carriers until closing. Served as the point of contact for all communication leading to resolution of new business and renewal application submission. Performed a variety of clerical activities such as case submitting, assembly and mailing of policy contracts, photo coping documents and filing documentation to case files for reinsurance management. Responded appropriately to inquiries regarding items such as policy status, provisions and benefits, premiums, billing issues and coverage. Researched, analyzed and solved problems for insureds and/or agencies/brokers regarding the status of new business cases. Provided ongoing agent support via phone/email.

Potomac Basin Group Associates

Beltsville, MD. 09/1994 – 09/1998

Customer Services Representative

Processed applications for changes to, reinstatement of or cancellation of insurance policies. Followed regulation timeframes and procedural guidelines for processing applications, updating and disenrollment activities according to company and contract standards Obtained State of Maryland Property and Casualty License. As a Health and Life Insurance Customer Services Representative duties included the responsibility for investigating and resolving claims issues. Contacted physician billing departments to request resubmission of corrected claims. Assisted members in collecting medical records and in submitting medical appeals to insurance carriers when necessary.

Skills:

Proficiency in Microsoft Word, Microsoft Outlook and Internet Explorer

Proficiency in the utilization of customer-relationship management software other software applications and databases and typing skills

Strong written and verbal communication skills.

Self- motivated, and resourceful with excellent organizational and time management skills.

Education:

Bachelor of Science, Health Care Administration

Grand Canyon University, Phoenix, Arizona

Anticipated graduation date: 06/2021

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