Customer Service Representative
Resume:
Amy Phelps
**** ****** ****** ********* *** Columbus, GA 31904
***********@*****.***
Skills
Proactive Self Starter
Customer Advocacy
Excellent Attention to Detail
Establishing and Maintaining Customer Relationships
Dedicated and Courteous with Strong Service Mindset
Inbound and Outbound Calling
Team-Oriented and Cooperative
Stand in for team questions and concerns when management is unavailable
Assist with training new hires as needed
“Question Time” Liaison when team needs assistance
Irate Caller Resolutions / high success rate to resolve issues without needing to involve upper management as originally requested
Experience
2005 - Current Utilization Management Representative II
Elevance Health (Formerly Blue Cross Blue Shield of GA)
Evaluate medical guidelines and benefit coverage to determine appropriateness of services.
Perform prior authorization review of services requiring notification.
Process incoming requests, collection of information needed for review from providers, utilizing scripts to screen basic and complex requests for precertification and/or prior authorization.
Acts as liaison between Medical Management and internal departments as well as outside vendors.
Follow up with members regarding authorization determinations.
Refers cases requiring clinical review to a nurse reviewer.
Acts as liaison between immediate supervisor and field call center questions
Assists with uptraining and answering questions for team’s case calls
100% goal of first inquiry resolution – I give my full first and last name because I am a firm believer that the issue starts and stops with ME. I am a customer as well, it may not be for the same things, but we are ALL customers at some point in our daily lives. I go the extra mile, always.
2003 – 2005 Customer Service Representative
Blue Cross Blue Shield of GA
Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
Answered customer telephone calls promptly to avoid on-hold wait times.
Answered constant flow of customer calls with minimal wait times.
Offered advice and assistance to customers, paying attention to special needs or wants.
Guided members and providers with their healthcare needs by explaining benefits, solving claim concerns, helping to find care via telephone calls or e-mails.
Liaised with customers, management, and sales team to better understand customer needs and recommend appropriate solutions.
Delivered exceptional customer service to every customer by leveraging extensive knowledge of products and services and creating welcoming, positive experiences.
Responded proactively and positively to rapid change.
Met customer call guidelines for service levels, handle time and productivity.
Reached out to other departments or providers on the member's behalf to resolve issues.
Education
1995 High School Diploma - Calvert High School Frederick, MD
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