Customer Care Telesales
Resume:
AW
ALFRIEDA WILLIAMS
********.********@*****.*** 704-***-**** Richmond, VA 23225
Customer Service Specialist with exceptional skill in client engagement, communication, consumer support, and problem solving. Proven ability to deliver individuals services designed to meet & exceed customer satisfaction Microsoft Office
People skills
Customer conflict resolution
Account inquiry resolution
Data confirmation
Patient scheduling
Registration documents
Verifying eligibility
Checking patient details
Multitasking
Aetna/CVS Richmond, VA
Inbound/Outbound Que Associate
05/2020 - 09/2022
Performs intake of calls from members or providers regarding services via telephone, fax, EDI.
Utilizes systems to build research and enter member information. Screens requests for appropriate referral to medical services staff. Approve services in accordance with the benefit plan. Performs non-medical research including eligibility verification, COB, and benefits verification.
Maintains accurate and complete documentation of required information that meets risk manage ment, regulatory, and accreditation requirements. Promotes communication, both internally and externally, Plan Sponsors, and third-party payers as well as member, family, and health care team members.
Protects the confidentiality of member information and adheres to company policies regarding confidentiality.
Communicate with Case Managers when processing transactions for members.
Maintain compliance with various laws and regulations, URAQ and/or NCQA standards, where applicable, while adhering to company policy and procedures.
Places outbound calls to providers to obtain clinical information for approval of medical autho- rization.
Use Systems, QNXT, ProFAX, ProPAT, and Milliman, to Communicates with Nurses and Medi- cal Directors, when processing transactions or entering diagnosis or CPT codes.
LandSoft Richmond, VA
Inbound/Outbound Que Associate
05/2019 - 05/2020
Use Systems, QNXT, ProFAX, ProPAT, and Milliman, to Communicates with Nurses and Medical Directors, when processing transactions or entering diagnosis or CPT codes.
Places outbound calls to providers to obtain clinical information for approval of medical authorization
Summary
Skills
Experience
Maintain compliance with various laws and regulations, URAQ and/or NCQA standards, where applicable, while adhering to company policy and procedures.
Communicate with Case Managers when processing transactions for members.
Performs intake of calls from members or providers regarding services via telephone, fax, EDI.
Utilizes systems to build research and enter member information. Screens requests for appropriate referral to medical services staff. Approve services in accordance with the benefit plan Performs non-medical research including eligibility verification, COB, and benefits verification.
Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements. Promotes communication, both internally and externally, Plan Sponsors, and third-party payers as well as member, family, and health care team members
Protects the confidentiality of member information and adheres to company policies regarding confidentiality
Communicate with Case Managers when processing transactions for members
GoHealth Charlotte, NC
Benefit Advisor
08/2017 - 01/2018
Guide consumers through the process of selecting the right health insurance and ancillary coverage
Interpreted and applied the various guidelines for insurance carrier to applicant-specific health scenarios
Achieved problem solving through research, collaboration and retention of knowledge
Detailed oriented and able to meet quotas while maintaining full compliance with policies and Federal and State regulation Ability to communicate clearly and effectively with both consumers and co-workers
Communicated the costs and benefits of major medical insurance plans through headset
Scheduled and began the process of health insurance renewals for all existing clients
Performed inbound and outbound call using two monitor screen for lead summary and five 9 application
Utilized the consultative skills to assess the client's needs Managed Aflac outbound and inbound calls.
Xerox Charlotte, NC
Telesales Specialist
09/2016 - 02/2017
Posses' positive attitude and friendly manner
Ability to ask probing questions to draw out additional customer wants and needs
Answer customer inquiries of benefit and group insurance programs Follow a sales methodology to uncover customer needs and match appropriate products and service to their needs
Enroll members into eligible coverage, change and update personal data Provide answers to customer coverage, also provide additional coverage as well as Special Enrollment Period,
Access customer account information to determine promotion eligibility Enter sales information into scripting, software for reporting purpose Remain current on changes in the service pricing and procedure, order entry process, and sales promotion through completion of the required recommend training process
Excellent communication and listening skills
United Health Group Customer Care,
Optum Concord, NC
Customer Care
07/2015 - 09/2016
Help Medicare eligible individuals understand features and benefits of Medicare Advantage and Part D prescription plans.
Utilize the internet to assist with Medicare approve discount drug programs and other related programs.
Respond to relate inquires of benefits, eligibility, material request, and physician look up, pre-authorization.
Explain explanation of benefits, and status check.
Resolve complaints and refund request.
Performed analysis lookup using Mysme.
Make outbound calls and transfer special projects and phone work/use of head set throughout the day.
Research of payment, billing, account balance questions with quality care. Respond to emails, written correspondence, order processing, and account maintenance.
Navigate between multiple application and input data quickly. Credit card payment and calculate premium payment. Explain and interpret prescription drug plan to retirees. Xerox Charlotte, NC
Customer Care Sr. Assistant Rep
10/2014 - 02/2015
Respond to customer inquiries using a computerized system in a call center environment.
Responds to telephone inquiries and complaints using standard scripts and procedures.
Gathers information, research/resolves inquiries and logs customer calls. Answer employer's questions on hospitalization, worker's compensation and pension.
Verify, document and contact insurance carriers.
Check Medicaid and private insurance in system, Enroll individuals into health plans.
Communicates appropriate options for resolution in a timely manner. Informs customers about services available and assesses customer needs. Provides functional guidance, training and assistance to lower-level staff. Provide and troubleshooting support to lower level staff. Schedules work to ensures accurate phone coverage #CD# monitors priority of calls and shifts escalated calls to assure. Prepares standard reports to track workload, response time and quality of input.
Assists in planning and implementing department goals and makes recommendations to management to improve efficiency and effectiveness. Kaplan University
Master of Health Administration
11/2014
University of Phoenix
Bachelor of Health Administration
01/2011
Education and Training
University of Phoenix Tempe, AZ
Associate of Science in Health Administration
02/2009
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