Sheena Taylor-Frazier

** ***** ******

Chickasaw, Alabama 36611

251-***-****

adp1jz@r.postjobfree.com

My objective is to obtain a full-time position with a growing and forward thinking company. I am reliable, hardworking with expertise in customer service, complaint handling/resolution, and customer relations. I have exceptional organization skills with strong attention to details

SKILLS

*Customer Service Skills *Computer proficiency *Certified in 10-key

*Type 50 WPM *Leadership experience *Communication skills

*Fast Learner *Hard Working *Efficient problem solver

*Results-oriented *Accurate Data Capture

EXPERIENCE

Molina Healthcare Provider Services/Claim Representative Virtual

03/2020-02/2022

●Answered inbound provider calls nationwide for subscribers of Molina Healthcare in NY, MS, CA, IL, OH medical insurance plans.

● Answered inbound calls from hospitals, medical practices and substance abuse/mental health facilities to answer medical policy insurance inquiries.

●Provided up to date benefit quotes stating copay, deductible, coinsurance, and out of pocket values for specific medical procedures.

●Researched cpt codes for various medical procedures giving the accurate benefit quote and supporting medical policies that may influence medical claim approval.

● Reviewed medical policy bulletins if applicable for providers with claim denials.

●Reviewed and submitted adjustments when claim denial errors are discovered.

● Explained provider offsets/refunds to providers when payments are recouped for claims paid in error

CVS Pharmacy Benefit Verified Representative Virtual

10/2018-03/2020

●Answer inbound calls from pharmacists and staff regarding denied claims and checking eligibility.

●Assisted member with issue of filling medication at pharmacy.

●Assisted member with new order and refill through mail order

●Assisted member with issue of not receiving or over charge of mail order

●Assisted member with check coverage and cost of medication

●Sent request to providers for medication refills

Conduent, Inc Tech Support/Senior Support Virtual

04/2016-10/2018

●Answering inbound calls assisting with iOS/macOS technical issues regarding their apple devices

●Assisted customer with starting and managing apple id accounts

●Assisted member with locked or lost devices

●Managed high call volume with tact and professionalism

●Handle escalated calls and provided senior support to tier 1 representatives

Auto Injury Solution Data Entry/ISL Claim Processor Daphne,Al

01/2013-04/2016

●Process over 25 auto claims daily and data captured over a 800 line daily.

●Organized medical billing/invoice data, data captured all charges and prepared accounts for adjuster.

●Contacted customers to give and receive missing documents for claim to be processed

● Made outbound calls regarding insurance verification or inquiries regarding billing codes for medical providers

EDUCATION

Satsuma High School Satsuma, Alabama - HS Diploma

08/2000- 05/2004

Remington College Mobile, Alabama - Medical Assistant/Billing Certification

04/2005-09/2006