Knowledgeable individual with more than 15 years' working as a Customer Service Representative for several well-run organizations. Determined and experienced in Customer Service and Administrative tasks. Excellent at juggling multiple tasks and working under pressure.
TTEC, Oklahoma City, OK: 01/2020 to Current
Licensed Property and Casualty Adjuster for the State of Oklahoma, New York and Hawaii
Investigate, evaluate, and adjust low to moderately complex claims presented by or against insureds to confirm coverage, and determine legal liability in compliance with all state regulatory requirements
Adjust low to moderately complex Auto or Property claims
Seek guidance from team members to resolve issues and identify appropriate issues for escalation
Contributes to business goals, performance metrics, and effectively uses tools & technology.
GlobalHealth, Oklahoma City OK: 02/04/2019 to 09/03/2019
Epic Efficiency and CES Specialist
Inputs CMS edits into a processing system.
Uploads all claims received from clearinghouses into EPIC.
Acts as liaison between claims, utilization management, and applications team to utilize all functionality within the system.
Works with vendors to create vendor/provider/claims associations for Global Link
Processes returned mail and returned checks
Task owner for Global Link, responsible for Building new accounts, Password resets, adding providers and designating access.
Built Provider, Vendor and Place of Service records in EPIC
Created, worked and closed tickets in JIRA IT system
Input missing provider or vendor information in pending claims.
GlobalHealth, Oklahoma City, OK: 04/17/2017 to 02/04/2019
Customer Care Representative Level ll
Responded to customer questions and concerns via telephone and email
Answered customer questions regarding benefits and coverages
Received inbound calls to answer clients' questions, about billing, payment processing, solve problems, and direct calls to appropriate departments
Assisted with Primary Care Doctor reassignments
Made outbound phone calls to follow up with questions or concerns to members and providers.
Assisted Physicians with verifying benefits or eligibility questions, and with claim and referral statuses
Mailed out all incoming Medicare member material requests.
Handled all Medicare return mail correspondence.
Processed all incoming Medicare disenrollment requests.
Responded to Medicare member incoming voicemails.
The backup person for department phone STAT's, PCP Reassignments and PTCRM's.
Optum Rx, Oklahoma City, OK: 04/15/2013 to 09/23/2016
Customer Service Advocate
Resolved all customer complaints in a professional manner
Assisted customers promptly and politely via telephone
Communicated directly with doctors’ offices via telephone, and electronically regarding prescription refills and Prior Authorization requests.
Gathered sensitive information to update customer profiles and verified HIPAA.
Worked with computerized and automated systems for dispensing medications and editing new patient profiles.
Directed calls to appropriate individuals and departments.
Answered customer questions about product availability and shipment times.
Recommended alternative items when products were out of stock.
The Hertz Corporation, Oklahoma City OK: 05/10/2010 to 04/15/2013
Insurance Replacement Agent
Took inbound calls and set up Insurance Replacement Rentals
Tracked the progress of all outstanding insurance replacement rentals.
Calculated quotes and educated potential clients on insurance rentals.
Identified issues and took appropriate action to ensure speedy resolution
Displayed a consistent positive attitude towards customers, peers and other personnel.
Evaluated the accuracy and quality of data entered for car rental reservations.
Calculated quotes and established payment methods for rentals.
Followed up with customers on unresolved issues.
Oklahoma City Community College - Oklahoma City, OK