AW

ALFRIEDA WILLIAMS

ads7ma@r.postjobfree.com 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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