Service Representative Administrative Assistant

Toreon Jefferson

(***) ***- **** ; *******@*****.***

Objective

Detail-oriented professional seeking a position as a Administrative assistant Strong verbal and written communication skills.

Summary

Self-motivated Customer Service Representative with 20 years of experience managing customers with clear and transparent interaction. Excellent communication skills combined with a profound ability to resolve problems arising to ensure recurring business opportunities.

Professional Experience

Magellan Health May 2002 —February 2021

Customer Care Associate II

Actively listened and probed callers in a professional and timely manner to determine purpose of the calls.

Researched and communicated information regarding member eligibility, benefits, EAP services, claim status, and authorization inquiries to callers while maintaining confidentiality.

Resolved customer administrative concerns as the first line of contact.

Comprehensively assembled and entered patient information into the appropriate delivery system to initiate the EAP, Care and Utilization management programs.

Demonstrated flexibility in areas such as job duties and schedule in order to aid in better serving members and help Magellan achieve its business and operational goals.

Educated providers on how to submit claims and when/where to submit a treatment plan.

Informed providers and members on Magellan's appeal process.

Made routine referrals and triage decisions that did not require clinical judgment.

Provided information regarding Magellan's in-network and out-of-network reimbursement rates and states multiple networks to providers.

Thoroughly documents customers' comments/information and forwards required information to the appropriate.

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