Customer Service Representative

FELICIA R. ROSS

PHONE: 615-***-****

EMAIL: ***********@*****.***

Professional Experience

CAREFIRST BLUE CROSS BLUE SHIELD Owings Mills, MD May 2021- Present

CUSTOMER SERVICE ADVOCATE II 40 hrs/ week

Responsible for answering member, provider & broker inquiries pertaining to product information, benefits, claims resolution, eligibility and billing questions in a call center environment. Proactively provides information and education to members, providers & brokers, as appropriate, about a variety of health, financial, and self-service programs. Provides basic technical assistance and troubleshooting guidance for digital and electronic applications.

Provides first- level problem resolution to member, provider & broker inquiries via telephone by gathering and researching information; examine claim submissions verifying claim and system accuracy as well as liability, validate customer understanding of information and resolves issues based on applicable policies and procedures.

Uses knowledge of products and the contractual provisions that govern administration to provide customer service and education, to interpret contractual language to the customer for the purpose of providing benefit utilization and limitations, to determine the need for managed care initiatives, and to administer all types of services to customers within the business segment through telephonic inquiries, written and/or electronic inquiries and claims adjustments, if applicable. Appropriately documents all client interactions according to established departmental procedures.

Delivers accurate information to customers in accordance with performance goals and objectives.

Maintains customer records by updating account information by effectively utilizing the business areas enrollment/inquiry tracking system & processes.

Participates in ongoing education related to new services, industry topics, and skills

EVOLENT HEALTH/Maryland Physicians Care Linthicum, MD Nov 2020- May 2021

CUSTOMER SERVICE REPRESENTATIVE 40 hrs/week

Receive inbound calls in a Call Center environment from providers, health plans and patients

Make telephonic outreach to health plans, provider offices and patients.

Assessing and assisting member with benefit inquiry and programs offered.

Complete notifications telephonically as well as by generating letter notifications to inform of authorized medical treatment determinations requests.

Utilize engagement strategies to build rapport.

Accurately document information received from members, provider offices, and health plan clients into Evolent’s system.

Perform clerical duties such as faxing and scanning documents, creating shipping labels, preparing letters and parcels using office machines, such as printers, photocopies, scanners, facsimile machines, telephone and voice mail systems and computer-based programs such as Microsoft Office.

Assist members and providers with claim reconsideration if process incorrectly.

Support UM functions by performing activities that do not require evaluation or interpretation of clinical information.

Explaining procedures and company policies as it related to providers and members benefits, claims and or authorizations.

Assist in completing daily tasks by participating in meetings and working closely with the management team and Client Services staff.

Perform other duties as assigned

SANTA ROSA COUNTY SCHOOL DISTRICT Milton, FL Sep 2017- Aug 2020

PRE-K ESE TEACHER 40hrs/week

Collaborates and coordinate with other teachers in full inclusion classrooms, instructional staff, other school personnel, parents and a variety of community agencies and accommodates, for the purpose of providing students with instructional materials that address individualized learning plans within established lesson plans that support of the school improvement plan.

Collaborates and coordinate with other teachers in full inclusion classrooms non-instructional staff to administer subject specific assessments, etc. for the purpose of assessing student competency levels and/or developing individual learning plans.

Provides instruction to students for the purpose of improving their success in academic, interpersonal and daily living skills through a defined course of study.

Responds to inquiries from a variety of sources (e.g. other teachers, parents, administrators, etc.) for the purpose of resolving issues, providing information and/or direction.

Supports classroom teachers for the purpose of assisting them in the implementation of established curriculum and/or individual student plans.

Assesses student progress towards objectives, expectations, and/or goals (e.g. behavioral, motor development and communication skills, academic needs, vocational abilities, etc.) for the purpose of providing feedback to students, parents and administration.

Monitors and manages student behavior, reports incidents (e.g. fights, suspected child abuse, suspected substance abuse, etc.) for the purpose of providing and maintaining personal safety of students, providing a safe, positive learning environment and adhering to state and federal laws and school board policies.

Participates in a variety of meetings, including Individual Education Plan (IEP) for the purpose of conveying and/or gathering information required to promote students’ educational, physical, and social/emotional development.

Prepares a variety of written materials (e.g. adaptive materials, grades, attendance, anecdotal records, Individual Education Plans, behavior logs, etc.) for the purpose of documenting student progress and meeting mandated requirements.

Advises parents and/or legal guardians of student progress for the purpose of communicating expectations; student's achievements; developing methods for improvement and/or reinforcing classroom goals in the home environment.

Responds to emergency situations, if nurse is not available, first aid and assistance to medically fragile children (e.g. tube feeding, toileting, diapering, etc.) to resolve immediate safety concerns and/or directing to appropriate personnel for resolution, for the purpose of providing appropriate care for children as assigned

Direct, supervise, coach and provide feedback to para-professionals and one on ones for the purpose of providing an effective classroom program and addressing the needs of individual students.

Performs other related duties, as assigned, for the purpose of ensuring the efficient and effective functioning of the work unit.

CHILDCARE NETWORK Gulf Breeze, FL Jan 2017- Sep 2017

EARLY CHILDHOOD EDUCATION LEAD TEACHER 30-50hrs/week

Lead, coach and mentor less experienced teachers in your classroom; model behaviors and provide feedback.

Planning, teaching and implementing the curriculum.

Providing love and quality care for the children throughout the day in order to meet their emotional and physical needs.

Create a safe, nurturing environment where children can play and learn.

Planning and executing indoor and outdoor experiences appropriate to the developmental levels of the children.

Interacting with children both physically and verbally throughout the day.

Cultivate positive relationships with families, teachers, state licensing authorities, community contacts and corporate partners.

Serve and eat meals with the children.

Meet with parents, staff, and administration.

Assist with growing the enrollment in the afterschool program.

Attend in-service and staff development training programs.

Familiarity with state licensing requirements and CNI policies.

VOLKSWAGEN CREDIT Libertyville, IL

Reason for leaving: Husband job relocation to FL JULY 2016 –Oct 2016

CUSTOMER SERVICE REPRESENTATIVE 40hrs/week

Direct client communication, examine and resolve issue related to customers automobile loans.

Effectively handle inbound calls by negotiating corrective action on delinquent accounts to ensure most profitable resolution while maintaining acceptable handle times.

Investigate and resolve customer through first call resolutions.

Make timely recommendations of corrective action to be taken to resolve delinquency.

Verify customer through personal questions and protect customer’s identity.

Process, follow up, and resolve inbound collection and customer service telephone inquiries.

Initiate, mail, and follow up for necessary processing of all customer correspondence.

Approve Extensions, Deferments and Due Date Changes within authorized limits to promote customer performance of contractual obligations.

Evaluate and execute collection follow up as further action is needed.

Investigate and resolve customer inquiries and complaints to mutual satisfaction of company and customer.

Resolve delinquent accounts in an ethically responsible manner by mitigating losses and maximizing receivable income.

Operate standard office equipment including word processors, computers, facsimile machines and telephones.

Schedule payments, collect payments and fees from customer on account.

Standard bookkeeping duties

KINDERCARE LEARNING CENTER Vernon Hills, IL Feb 2016-July 2016

LEAD TEACHER

Lead, coach and mentor less experienced teachers in your classroom; model behaviors and provide feedback.

Implement KCE’s curriculum in a way that is consistent with the unique needs of each child.

Create a safe, nurturing environment where children can play and learn.

Partner and communicate with parents, with a shared desire to provide the best care and education for their children.

Support your center’s success; partner with center staff and leadership to achieve goals around enrollment, accreditation, and engagement.

Cultivate positive relationships with families, teachers, state licensing authorities, community

contacts and corporate partners.

KELLY SERIVICES/CGS ADMINISTRATORS Nashville, TN

Reason for leaving: Temporary position Sep 2015-Feb 2016

RECORDS CLERK 40hrs/week

Ensures the accuracy and quality of medical claims that has been systematically or manually entered an indexing system.

Sort incoming mail into medical claim classifications.

Research and process all intermediate level claims transactions.

Process correspondence and customer service inquires as related to claim transactions.

Correct medical claims entered into system for fining

Train new employees on sorting mail and correcting claims data.

Operated mail slicing machines for opening multiple envelopes at once.

GROSS BUILDERS Gallatin, TN

Reason for leaving: Not enough hours June 2015-Sep 2015

LEASING CONSULTANT 30-40/hrs week

Created and maintained a welcoming office environment for potential resident by providing refreshments, cleaning and opening the model apartment for tours and completes daily inspection.

Screened and selected qualified and appropriate applicants in accordance with the housing policies as well as Equal Housing opportunity guidelines and local laws.

Demonstrated complete knowledge of the features and benefits of the community as well as trends and features of the local market to better position the Company’s offerings versus competitors.

Prepared stocks and distributed all leasing materials including move-in packages for new residents, renewals and marketing materials in the leasing office for potential residents on a first visit.

Updated spreadsheets on a monthly basis for apartment competitors.

Input perspective resident information into Microsoft word and excel for qualifications.

Standard bookkeeping duties and skills.

AMERIGROUP Nashville, TN

Reason for leaving: Downsized Department Dec 2014-June 2015

CUSTOMER SERVICE REPRESENTATIVE 40hrs/week

Functioned as an information source through telephonic assistance to members, providers, billing agencies, and various company/department staff.

Provided pleasant customer experience through superior customer service methods, problem solving and real-time issue resolution.

Handle customer disputes and conflict billing issues.

Interacted with provider community and various departments to resolve issues involving the membership and credentialing status.

Explained benefits, eligibility status, enrollment processing procedures and status of authorizations and referrals to callers.

Assisted with activities to ensure memberships continuity of care.

Conducted member outreach calls as assigned to proactively educate members on services available (Welcome Calls), complete health assessments for plan case management (Early Case Findings and Healthy Beginnings) and conduct membership surveys.

Updated spreadsheet for participating providers

Operated regular office supplies including facsimile and scanner machines, computers and telephones.

HARRIS TEETER Nashville, TN

Reason for leaving: Maternity leave Jan 2014-May 2014

PHARMACY TECHNICIAN 20-25hrs/week

Operated checkout system and verified change refunded.

Maintained pharmacy inventory by checking pharmaceutical stock to determine inventory level, anticipating needed medications and supplies, placing and expediting orders, verifying receipt, and removing outdated drugs.

Maintained a safe and clean pharmacy by complying with procedures, rules, and regulations.

Protected patients and employees by adhering to infection-control policies and protocols.

Organized medications for pharmacist to dispense by reading medication orders and prescriptions, preparing labels, calculating quantities, assembling intravenous solutions and other pharmaceutical therapies.

Maintained records by recording and filing physicians' orders and prescriptions.

Generated revenues by calculating, recording, and issuing charges.

Located items for customers upon request.

Ensured medication availability by delivering medications to patients and departments.

Participated in inventories.

Arranged stock on shelves to keep up with merchandise available.

WALMART Conway, AR

Reason for leaving: Relocated to different college due to major change May 2012-Dec 2013

CUSTOMER SERVICE CLERK 30-35 hrs/week

Provided information to customers by verifying understanding of request, answering questions, and offering assistance.

Operated computer systems and calculated price of merchandise.

Initiated service by recording requests and forwarding to dispatching.

Operated checkout system ensured change amount and amount of money collect during the specific shift.

Changed printer/register tape when needed.

Resolved billing problems by identifying the problem, explaining procedures, and forwarding required adjustments.

Located items for customer, and answer questions concerning price.

Arranged merchandise on shelves and displays and labeled merchandise.

Improved quality results by evaluating processes and recommending changes.

Handled grocery items with proper care.

Assisted customers with self-check-out machines and procedures.

Ensured machines obtained adequate amount of money.

Education

Masters of Education in Curriculum and Learning University of Phoenix Anticipated Dec 2021

Bachelor of Liberal Arts Tennessee State University May 2015

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