Customer Service Representative
Resume:
Shameka Crennel
Petersburg, VA *****
**********@*****.***
Looking for a long term full time job where I can apply my extensive skills and knowledge to the position for which I am hired.
Authorized to work in the US for any employer
Work Experience
Customer Service Representative
Alorica/Express Scripts - Niles, OH
June 2022 to Present
• Help patients better understand the Home Delivery benefit. Use expert knowledge and consultative sales approach to educate patients on the benefits of receiving their medication via home delivery, helping them to understand why it’s a good fit for lifestyle.
• Help patients get the medication they need. research issues on benefits coverage with pharmacist and doctors’ office and provide guidance to patients about medication coverage.
• Juggle multiple tasks without sacrificing attention to detail. handled multiple requests at any given time as well as documenting information from conversations in the computer system. Customer Service Representative
WPS Health Solutions - Hampton, VA
March 2022 to April 2022
• Answer inquiries from beneficiaries, providers, and other affiliated representatives or groups regarding TRICARE eligibility, benefit determinations, and claims adjudication questions or problems
• Receive telephone, written, fax, and e-mail inquiries concerning TRICARE eligibility, benefits determinations, and claims adjudication questions or billing problems
• Apply appropriate provisions of TRICARE regulations, interpretations, and procedural directives in making determinations on eligibility and benefits to determine appropriate responses to inquiries
• Obtain and analyze claims data to determine specific problem area including external communication to obtain data
• Complete research and provide final resolution to inquiries within contractual requirements
• Communicate with inquirer to determine appropriate authorization or referral of services
• Submit claims for adjudication, correction, payment, or review as appropriate
• Educate providers on billing requirements of TRICARE to reduce claim problems
• Deal tactfully with people in a wide variety of situations to convey a favorable corporate image
• Respond to inquirer using various forms of communication (written letter, telephone, web, or email) within time frames to exceed contractual standards
• Collect and record data for Customer Service records and computer analysis Eligibility Specialist/Counselor
Integrated Resources Inc - Edison, NJ
April 2021 to February 2022
• review applications for Medicaid and ensure that applicants are eligible
• verify that any application forms have been filled out correctly and checking the information on the forms for accuracy.
• Process Application to determine eligibility
• Completing reviews of assigned cases within the required timeframes.
• Gathering documents, inputting information, and calculation income submitted in efforts of making a recommendation to either Continue, Cancel, or Change the status of currently active Medicaid cases.
• Responding to phone calls, written, and electronic inquiries within required timeframes.
• Meet all standards established for the position as outlined in the corresponding annual performance
• Criteria and bonus template for specialists.
• Performs other duties as may be assigned by the Project Manager, Operations Manager or Eligibility Supervisor.
Homemaker
Crennel Household
May 2009 to April 2021
• Effectively perform housekeeping and home management duties
• Manage schedules and logistics
• Manage, implement, and coordinate multiple schedules and activities
• Manage financial activities including cash management, budgeting, overseeing, and ensuring bills are monitored and paid in a timely fashion
• Manage all household maintenance
Crew Member/CSR
McDonald's - Hopewell, VA
June 2008 to November 2008
• Accepted and processed customers payments in cash and/or credit
• Processed and filled customers' orders in a timely manner
• Measured and prepped raw food materials
• Operated high volume cooking and assembly equipment
• Operated drive-thru window and sales register
• Maintained clean and safe environment including dining area, bathrooms, kitchen, parking lot, sidewalk, and dumpster
• Pleasantly and courteously interacted with customers
• Greeted and provide excellent customer service
Education
Bachelor's in Healthcare Administration/Management University of Phoenix-Online Campus
April 2013 to July 2015
Skills
• Internet & computer skills
• Organizational skills
• Time Management
• Strategic Planning
• Logistics
• Forecasting
• Maintenance
• Budgeting
• Cash Management
• Housekeeping
• Customer Service
• Written an verbal communication
• Training
• Microsoft Office
• Computer Networking
• Typing
• Document review (Less than 1 year)
• Windows
• Customer support
• Medicare
• Communication skills
• Computer skills
Groups
The National Society of Leadership and Success
March 2020 to Present
• Completed leadership training
• Attended speaker broadcasts
• Participated in student networking teams
Contact this candidate