Customer Service Process Technician

Susan E McNamee

Customer Service Professional

904-***-**** ***********@*****.*** Jacksonville, FL 32223

About Me

I am a highly motivated customer service professional with extensive experience. I am an energetic self-starter that looks forward to the next challenge; finding answers and providing resolutions I am a firm believer in Servant

Leadership; ensuring that coworkers and staff are successful and empowered. I am able to remain focused and

productive each day though tasks may be repetitive. I can navigate a computer while on the phone and multi

- task; including the ability to understand multiple products and multiple levels of benefits within each

product.

Experience

Customer Service Agent September 2020 – March 2022

Mican Technologies (under contract with FloridaBlue) - Jacksonville, FL

•Research complex issues across multiple databases and work with support resources to resolve

•customer issues and/or partner with others to resolve escalated issues

•Work through and monitor a daily queue of resolution and escalation cases to ensure timely resolution to the member’s concern, question, or problem.

•Provide timely updates to leadership regarding Medicare escalations in accordance with Medicare requirements

•Ask appropriate questions and listen actively to identify specific questions or issues while

•documenting required information in computer systems

•Contact care providers (doctor’s offices) or suppliers on behalf of the customer to assist with obtaining

•durable medical equipment, prescriptions or authorizations when needed

•Assist customers in navigating FloridaBlue websites while encouraging and reassuring them to become self-sufficient in using the available tools

Customer Service Supervisor/Call Center January 2016 - March 2020

OptumRx - Jacksonville, FL

•Coordinate, supervise and is accountable for the daily/weekly/monthly activities of all team

•members

•Set priorities for the team to ensure task completion and performance goals are met, such as

•Quality, Adherence, Productivity, Compliance and Customer Satisfaction

•Using Salesforce created and tracked cases to resolve customer concerns, appeals and grievances

•Provided daily/weekly/monthly reports to leadership using SalesForce to show progress

•Coordinate work activities with other supervisors, managers, departments, etc.

•Identify and resolve operational problems using defined processes, expertise, and judgment

•Provide coaching and feedback to team members, including formal corrective action

•Conduct annual performance reviews for team members

•Provide expertise and customer service support to members, customers, and/or providers

•Fast pace call center environment, focused on creating the best possible patient experience for the

•members, as well as the best possible employee experience for our agents

•Designed and created monthly data analysis of case volume and case type for Operations

•Management team; presented via WebEx

Customer Service Advocate and Lead February 2013 - December 2015

OptumRx - Jacksonville, FL

•Answer 75 - 125 incoming phone calls per day from customers and identify the type of assistance the

•customer needs

•Ask appropriate questions and listen actively to identify specific questions or issues while

•documenting required information in computer systems

•Contact care providers (doctor’s offices) on behalf of the customer to assist with obtaining

•prescriptions or authorizations when needed

•Assist customers in navigating OptumRx and UnitedHealth Group websites while encouraging and

•reassuring them to become self-sufficient in using our tools

•Research complex issues across multiple databases and work with support resources to resolve

•customer issues and/or partner with others to resolve escalated issues

Senior Billing Specialist February 2011 - December 2012

TDC, PA - Jacksonville, FL

•Oversee all aspects of coding and billing for 4 general practice centers

•Process charges to clearinghouse for submission to insurance carriers

•Post payments to patient accounts when money is received from insurance carriers and patients

•Reconciliation of daily money received

•Resolving insurance denials received

•Assisting patients when they call on the telephone

•CPT, ICD-9, and HCPS coding

•Assisting the physicians with credentialling paperwork and submission

Education

Howard Community College - Columbia, MD [1983 – 1987]

Associates Degree – Business Management

Howard High School - Ellicott City, MD [1979 – 1983]

Diploma – General Studies/Business Management

Military Service

U.S. Navy [1989 – 1993]

Data Process Technician – E5

Skills

SalesForce Power BI Microsoft Office Medical Terminology Visio ServiceNow Customer Connect Seibel

Sapphire NICE Microsoft Teams RxClaims

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