Customer Serive Rep
Resume:
Tayana Kemp
Topeka, KS *****
************@*****.***
I am a professional customer oriented agent with a focus on providing individualized service to all consumers. Rather recommending products and services or providing assistance with account management, I help support each branch to achieve its targets. I have thorough understanding of HIPPA regulations, policies and procedures, and other compliance issues. I am a quick learner, team player, and a person of integrity.
I would love the opportunity to show how my experience would be an asset to your team! Authorized to work in the US for any employer
Work Experience
Eligibility Specialist
CFA STAFFING - Topeka, KS
June 2022 to Present
• Analyzes initial applications and reviews (for Family Medical programs) and supporting documentation provided by applicants to determine eligibility for federal and state medical assistance.
• Investigates applicant circumstances through available computer systems
• researching records provided by the applicant and their contacts to provide the information about the household.
• Entering household information and authorizing eligibility within the Kansas Economic and Enforcement System (KEES).
• Completes determinations using State and Federal regulations to determine eligibility for medical benefits based on financial and non-financial criteria.
• Document the eligibility decision in the electronic case journal and send appropriate system-based and manual correspondence to customers and representatives explaining the results of the eligibility determination and information regarding appeal rights. Membership Enrollment Specialist
Medix Staffing Topeka - KS
May 2021 to March 2022
• Provides Level 1 support by answering incoming calls regarding Enrollment, Eligibility and/or Premium Billing Questions.
• Collaborates with internal and external Bright Health Partners to resolve Enrollment and Eligibility issues.
• Facilitates collection of outstanding premium(s).
• Work with State-based exchange and Federal Facilitated Market place (FFM) to resolve enrollment, premium, APTC/CSR disputes, or discrepancies.
• Participate in the discovery and resolution of root cause for recurring issues.
• Work with Members in grace period to resolve billing issues and/or collect outstanding premium.
• Ensure that all customer needs and problems are properly communicated and managed in away that maintains great customer relationships.
Customer Service Specialist
Maximus - Lawrence, KS
August 2019 to March 2021
• Answer incoming calls from consumers including the general public with all performance standards, policy and procedures, and protocols including but not limited to the confidentiality and privacy policies.
• Track and document all inquiries using the applicable systems.
• Facilitate the fulfillment of caller requests for materials via mail, email, or download.
• Transfer/refer consumers to appropriate entities according to the established guidelines.
• Escalate calls or issues to the appropriate designated staff for resolution as needed. Acknowledgements Clerk
Aegis Processing Solutions - Topeka, KS
August 2017 to December 2018
• Mail production, using machinery to print mail, batching & sorting
• Use of Excel and Word for record keeping, mail prep, inventory calculation, and inventory budgeting
& control
• Extra duties as assigned.
Data Entry Specialist
KDHE - Topeka, KS
November 2016 to March 2017
• Data entry of applications into state KEES system
• Use of Outlook for communication and updates, Excel spreadsheet for data entry logging
• Providing mail room support; preparing, batching, re-stocking supply inventory
• Maintaining accuracy and organization of mail filing records
• Light administrative duties using copy/fax machine Account Services Representative
Se2- Security Benefit - Topeka, KS
January 2016 to September 2016
• Customer service role responding to annuity account inquiries, processing stock portfolio changes, mathematical calculations, and handling disputes
• Educating on and up-selling products and services
• Searching files, reviewing statements, preparing informative correspondences of financial transaction details
• Providing management assistance handling lead/sup call volume Client Service Representative
Maximus - Topeka, KS
April 2015 to October 2015
• Providing telephone services for Kancare recipients, explaining status of coverage and application process
• Collecting and reporting data to eligibility worker and communicating with MCO's for services
• Use of dual screen to navigate and reconcile information through KASI and KEES state system
• Preparing and printing correspondences to be mailed
• Occasional Data entry of applications into system during downtime Customer Service Representative
Berlin-Wheeler - Topeka, KS
June 2013 to April 2015
• Scheduling transportation services over the phone as Medical Transportation Management through Medicaid
• Organizing availability with vendors, informing with electronic fax service
• Adhering to strict HIPPA privacy policies and health plan protocols to enforce guidelines.
• Outbound call back services for quality compliance Customer Service Representative
Alorica - Topeka, KS
June 2011 to June 2013
• Handling high/fast pace call volume
• Ensuring customer satisfaction, de-escalating irate callers, maintaining exceeding performance stats
• Constant multitasking, inputting data, processing payments, calculating bill estimates, and technical support
• Offering and performing sales of services more beneficial to meet needs of customers Education
High school diploma in HHS/Hope Street Academy, Topeka, KS # HS Diploma May, 2011 # GPA 3.75, Teachers Honor Roll Student, HS Office Assistance Hope Street Charter Academy
Skills
• Insurance Verification
• HIPAA
• Microsoft Office
• Research
• Call center
• Case Management
• Customer service
• Data entry
• Organizational skills
• Attention to Detail
• Communication skills
• Articulate and Analytical
• Word processing
• Microsoft Excel
• Administrative experience
• Time management
• Flexible
• Team Player
• Multitasking
• Office experience
• Technical Support
Languages
• English - Expert
Additional Information
References:
Carla Espinoza Co-worker/Friend 785-***-****
Melinda Mendoza Co-worker/Friend 785-***-****
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