Customer Service Representative
Resume:
Ashley Turner
Jacksonville, FL
**********@*****.***
Professional Summary
Seek to function as a Customer Service Representative in the company of an awesome organization bringing exceptional communication and interpersonal skills. Eager to join the company to grow customer loyalty and maintain the highest level of customer service. Focused on providing a wonderful experience to customers by responding swiftly and courteously in a professional manner to customer needs and demands.
Willing to relocate: Anywhere
Authorized to work in the US for any employer
Work Experience
Eligibility Specialist
Savista LLC-Jacksonville, FL
June 2024 to September 2024
• Interviewing applicants and determining eligibility for benefits or assistance for programs such as Medicare, Medicaid, disability, and charity services
• Providing case management services to a high volume of caseloads of patients by completing an assessment and determining initial eligibility.
• Facilitates the application process or directs the patient to the next appropriate step.
• Submit applications and supporting documentation to the appropriate institution in accordance with company protocol and deadlines.
• Following up with the patient, hospital, state/federal programs and receiving facility for missing requirements.
• Responding to all inquiries and concerns timely.
• Act as an advocate for the patient, but also serves as a liaison to other colleagues, client hospital personnel, and government agency staff in a collaborative effort to establish eligibility coverage for future and incurred medical expenses.
• Communicating with other institutions for fact-checking
• Referring households to outside community resources if needed
• Provide superior customer service and maintains a professional image.
• Meet or exceed established productivity, quality, and revenue metrics.
• Entering all required data into computer systems
• Organizing files accurately
• Follow-up with any other tasks or duties as assigned Customer Service Representative
RemX Specialty Staffing-Jacksonville, FL
October 2023 to February 2024
• Performed data entry clerical functions and and Inbound phone calls by building patient account for enrollment into medical assistance programs
• Take inbound calls a triage them to appropriate department
• Maintaining patient accounts, record and document account information
• ICD-10 Experience and case management
• Follow communication guidelines, policies and procedures
• Maintains data entry requirements by following data program techniques and procedures.
• Purges files to eliminate duplication of data.
• Follow case management procedures with patient accounts and correspond with healthcare providers in relation to patient’s cases to ensure patient’s get medically necessary treatment that are available to them
• Receives documentation pertinent to patient's accounts and upload the information into patient's file
• Send faxes to different entities to ensure all information is received and updated
• Act as the first point of contact for patient's, providers, and claims using data entry, inbound/outbound calls and faxes
Fraud Analyst I
Genpact-Jacksonville, FL
November 2021 to June 2022
• Answered approximately 100+ inbound calls from credit card customers, by investigating and researching accounts in question for possible fraudulent transactions done by commercial card lines, also made outbound phone calls to verify transaction to prevention, and minimize financial losses, Conducts outbound calls to merchants and/or cardholders to complete reasonable investigation within regulatory timeframes
● Maintains thorough and current knowledge of all applicable federal, state, and local regulations
(including but not limited to all FCRA requirements, FDIC Red Flag Guidelines), ensuring that regulatory (Reg E and Z and any other applicable Regulation) and compliance requirements are met
● Performs/originates chargebacks on POS/ATM PIN cases to ensure recovery and minimize loss to clients according to the facts of the case.
• Analyze loan applications for fraud and approve loan applications accordingly in a production environment
• Help customers with posting payments to account and/or update payment methods
• Approve or deny payment waiver fees and help set up payment arrangements to account to bring account current
• Support fraud and claims functional area by proactively identifying opportunities to improve customer experience, and offer ideas to mitigate risks and losses through effective authentication of customers in order to prevent fraudulent activities. Operating generated software to verify customer’s information securely in order to monitor and review suspicious activity
• Provide superior customer service to customers through inbound/outbound calls and 1:1 text chat channels
• Contact and receive inbound by calls from account holders to verify identity and questionable transactions to prevent fraud
•Provide management of account, by red flagging and freezing account
● Re-issuing of new card to mitigate loss if account was compromised
• Document and update reporting systems
• Review incoming credits limit increase requests within the approval limit
• Ask preliminary questions to confirm if fraudulent claims needed to be made on account
• Reviews reports and monitors account transactions that are potentially fraudulent, by summarizing the key points of the investigation and identifying patterns and trends to prevent future fraud
• Keep tabs on transactions that may be potentially fraudulent, Once a potential risk or fraud has been identified, contact customers to confirm their account activities
● Start- Up and process fraud claims and send them through an investigation process for dispute on fraudulent transactions made to account
● Provide customer information and updates in regards to claim process and status Process Associate
Genpact-Jacksonville, FL
July 2018 to August 2021
• Assist our community and help resolve inquiries empathetically, accurately and on time
• Become and remain knowledgeable about client’s products and community standards
• Make well balanced decisions and personally driven to be an effective advocate for our community
• Strong interpersonal skills, verbal and written communication skills and most importantly empathy
• Display a strong bias to doing what’s right for our community in supporting the client’s mission
• Investigate and resolve issues that are reported on clients site such as requests for account support and reports of potentially abusive content
• Respond to user inquiries with high quality, speed, empathy and accuracy
• Use market specific knowledge, signals and insights to spot and scope scalable solutions to improve the support of our community of users
• Gather, analyze and utilize relevant data to develop ways to improve the overall user experience on the site
• Enforce Client’s Terms of Use by carefully monitoring reports of abuse on the site
• Review the reported content within agreed turnaround times and standards of quality
• Identify inefficiencies in workflows and suggest solutions Customer Service Representative Tier 2
Florida Blue (Blue Cross and Blue Shield of Florida)-Jacksonville, FL October 2017 to December 2017
• Kept records of member complaints and the ability to handle escalated calls when needed, also routing to correct department as well
• Reviewed accounts and make sure information was accurate and updated. Notated accounts as needed
• Ability to understand and become knowledgeable of standards, policies & procedures, maintaining the Privacy Act and HIPAA regulations, adhering to compliance of these and other standards
• Supporting the licensed sales agents, by creating leads- in order to expedite the open enrollment process
• Ensured that Florida Blue's brand was protected by providing excellent customer service with warm and professional attitude
• Maintained performance in high volume call center during open enrollment period
• Assist with escalation of phone calls, also came up with various plans/scenarios to devise and de- escalate phone calls and gave better solutions with team members when dealing with customers while taking calls
• Acted as an acting manager and helped supervised team members over periods of times when manager wasn't available to assist
• Selected to work for a special Coaching/Training Project- Premera Washington Project. A special out of state healthcare project for open enrollment season
• Met and exceeded 89% or above adherence for quality, focusing on KPI's and achieving weekly/monthly performance goals
• Operated Salesforce and Five9 Software
• Assisted member with a warm and professional attitude • Booked member appointments as needed Sales Associate I
Convergys Corporation-Jacksonville, FL
February 2017 to August 2017
• Working in the Concierge Refill Department helping members refill their medications by contacting pharmacy to ensure they have their medications when needed
• Open member accounts, updated and recorded member information
• Selected to work on the Rx Ed project, enrolling/creating leads for Humana Pharmacy to help enroll members to receive their prescriptions through Humana
• Skilled in using Citrix and Argus systems applications.
• Assisted members on how to reset their passwords and username by phone and chat
• Assisted members to navigate throughout Humana's pharmacy website
• Selected to work on special project, Provider Simplicity, persuading members to switch from retail to mail order providing them with great conveniences and benefits
• Responsible for achieving specific sales targets and maximizing sale opportunities on each and every call
• Received inbound and made outbound calls to members
• Attentive to member needs and concerns; demonstrate empathy while maximizing opportunity to build rapport with the member
Education
General Education Diploma
Turner Job Corp Center - Albany, GA
Skills
• Ability to type 45wpm
Additional Information
References
Available Upon Request
Contact this candidate