Keisha Stallworth

adn3an@r.postjobfree.com

Columbus, GA 31907 (C) 706-***-****

Core competencies: Certified Six Sigma Black Belt Professional, Process improvement, Operations management, Customer Service, Training & Development, Claims analysis, Data analysis, Facilitating Presentations, Data Entry, Case Management, SharePoint, Zendesk, Gladly, Confluence, Microsoft Teams, Shopify, E-Commerce, Help Desk, Tech Support, Client Escalation Resolution, JIRA, Excel, Shopify, PowerPoint, EPIC, Salesforce, Confluence, Chat Support,

Professional Experience

• 10 years Customer Service experience (Chat, E-mail, phone & Social Media)

• Extensive oral and written communication skills

• Analytical ability to research information for accurate resolution for customers

• Possess ability to lead team members and international customer service vendors

• Attention to detail obtaining all pertinent facts on initial encounter

• Works independently or as part of a team with or without supervision

• Always courteous and follows up on open encounters

• Exceptional time management

• Exceptional work ethics, dependability, reliability

• Computer Literacy: Type 55-60 wpm – 95% accuracy, Microsoft Works Suite (Word, Excel, Access, PowerPoint), Microsoft Outlook, Web Browsers (Internet Explorer, Mozilla FireFox, Netscape Navigator, Safari, Google Chrome) ; IBM Rational ClearQuest, Wellpoint Content Framework, Call Care Browser, Wellpoint Group Systems (WGS), EPDS, NetworX, ePACT, CIRS, Customer Experience Desktop (CED), Webmaster, PEGA, FACETS, additional skills in PC hardware/software, EPIC, SalesForce, CRM Systems

Best Choice Products

Escalations Support 05/2020 – Current

• Responds via (Gladly/Zendesk) to and manages complaints and escalations from clients and customers

• Maintain record of daily data communication transactions, problems and remedial action taken of all active investigations and prioritize workload

• Identify, manage and record escalation trends and collaborate with teams on product defects and trends

• Collaborate with other workgroup teams to train using process and procedures based on historical experience.

• Review and identify root cause for all escalated service requests and use this information to improve continuously within service delivery teams.

• Managing escalations relating to products or services, handling problem tickets, and providing feedback to upper management regarding customer issues.

Anthem 10/2009 – 03/2020

Grievances & Appeals Analyst

• Represents the highest level of expertise that is required to respond to regulators, media inquiries, member and provider issues escalated to the Executive Leadership Team (ELT) and regulatory agencies

• Reviews, analyzes and processes non-complex grievances and appeals in accordance with external accreditation and regulatory requirements, internal policies and claims events requiring adaptation of written response in clear, understandable language.

• Analyzes and renders determinations on assigned non-complex grievance and appeal issues and completion of the respective written communication documents to convey the determination.

Anthem

Claims Representative II,

• Researches and analyzes claims issues.

• Researches, analyzes and recommends resolution for provider disputes.

Adjusts voids and reopens claims on-line within guidelines to ensure proper adjudication

• Responds to telephone and written inquiries and initiates steps to assist callers regarding issues relating to the content or interpretation of benefits, policies and procedures, provider contracts, and adjudication of claims.

• Reviews, analyzes and processes claims/policies related to events to determine extent of company's liability and entitlement.

• Good understanding of the application of benefit contracts, pricing, processing, policies, procedures, gov't regs, coordination of benefits, & healthcare terminology.

Anthem

Operations Expert

• Serves as a first line resource for operation associates for workflow and technical related processes

• Provides operational training

• Assists associates by answering day-to-day technical questions for first call resolution (FCR); encourages a teamwork environment

• Monitors inventory to ensure workflow remains uninterrupted

• Handles complex case research and resolution

• Reviews, interprets and maintains records of service level, quality, accuracy, and productivity

• Reviews department policy and procedure manuals for accuracy

• Works with training department to ensure procedures and policies are accurate and complete.

• Performed team audits to ensure calibration of First Call Resolution surveys

• Analyzed surveys weekly for multiple teams in order to track and trend opportunities to improve FCR

• Provide technical direction, guidance and resources to customer service associates on a daily basis

• Provide operational training by assisting associates with technical questions

• Review, interpret and maintain records of service level, quality, accuracy and productivity

• Continue to perform the essential duties of a CCR III below

Anthem

Customer Care Representative III

• Independently or as a team member, based on supervisor or an escalated request, I consistently correspond either telephonically or electronically with multiple vendor managers, claims managers, operations experts, regional network relations managers, and area directors, to resolve aged claims or provider contract related issues.

• As the senior customer care representative on 2nd shift, I receive all irate and escalated calls; I collect data and historical background information, de-escalate the call, explain the corrective action needed, and provide timeline for correction and resolution if I am not able to key, adjust, or process the claim myself.

• Develop training aids and work flow reports for the local team and international customer service vendors.

• Continue to perform the essential duties of a CCR II below

Anthem

Customer Care Representative II

• Consistently diagnosed and resolved provider and member claims and benefit related issues.

• Showed empathy and assisted customers with utmost respect, striving for one-call resolution to problems.

• Trained and assisted newly-hired customer care representatives on the system, benefits, claim adjustment, processing and keying of new claims and our company policy.

• As an Inventory Reduction Team Member, I developed a process for tracking each individual agent’s inventory opened & was in charge of daily reporting of provider team and international customer service vendors' inventory, to senior leadership.

• Assisted with training for offshore (Teletech/APAC) provider reps, created workflows, maintained SharePoint site, and handled escalated provider issues for offshore leads.

Aflac

Client Services Representative II, 06/2015 – 10/2016

• Served as liaison for providers to resolve claims issues, policy interpretation, and other complex case resolutions.

• Coordinates communications process on such issues as administrative and medical policy, reimbursement and provider utilization patterns.

• Submits and routes complete applications for loading.

• Serves as point of contact for other internal departments regarding provider issues that may impact provider satisfaction surveys.

• Researches, analyzes and recommends resolution of provider disputes as well as issues with claims.

• Consistently diagnosed and resolved provider and member claims and benefit related issues.

Contact this candidate