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Customer Service Representative

Location:
Springfield, VA
Posted:
October 25, 2022

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Resume:

Elaina Wilkins

EXPERIENCE:

Genpact –

Compliance, Management & Insurance Claims Liaison July 2019 - Present

Liaison between various stakeholders at Genpact, licensing company and team leaders.

Ensure that all documentation is fully compliant as per licensing requirements, in a timely manner.

Perform compliance checks as per agreed procedures.

Monitor claims allocation is in line with state licensing.

Prepare regular reports and dashboards.

Work with operating leadership to develop mitigations to any compliance risks.

Work with Legal and Compliance teams and coordinate on necessary action plans.

Follow up communications with resources relating to Licensing & renewals.

Support recruiting / credentialing department to further build network coverage.

Maintain communication channels with other functions and Ops teams.

Monitor caseloads and adjust when needed.

Any and all other tasks assigned within the units.

Geisinger Health Plan

Customer Service Representative August 2018 - February 2019

Assisted Customer Service Team Leader in resolving customer concerns, providing appropriate education/instruction and maintaining customer satisfaction by providing the highest level of customer service in only one of the Primary Functions (enrollment, claims or phones)

Proficient in multiple GHP lines of business including Medicaid & CHIP

Excellent communication, problem solving, and customer-service skills within a team atmosphere

Assisted Medicaid caller with verifying active coverage, covered medications, prior authorizations

Communicated with doctors, nurses & pharmacies for medical history

Reviewed paid and denied claims with members by explaining how the process works

Reviewed claims that were sent to the incorrect payor and reached out to clinics for claim to be resubmitted for correct payor based on members benefits

Called collection companies to notify them of payments received on past due accounts

C3I

Level 1 Analyst August 2015 - October 2016

Performed routine clerical functions

Resolved incoming telephone requests for technical assistance on standard commercial and proprietary applications

Created and submitted detailed call logs

Troubleshoot issues reported and resolve or escalate to the appropriate contact

Work within service level agreements, including but not limited to average speed of answer, average talk time, abandon time, and hold times.



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