Customer Service Support
Resume:
Carl DeSantis
Garden City, NY *****
***********@*****.***
Summary
Dynamic customer service professional with a proven track record at EmblemHealth, excelling in resolution facilitation and compliance management. Expert in effective problem resolution and detail-oriented data management, consistently enhancing customer satisfaction through proactive support and conflict resolution strategies. Committed to maintaining high standards of professionalism and service excellence.
Skills
Customer service
Resolution facilitation
Detail-oriented data management
Compliance management
Comprehensive understanding of products
Customer support operations
Insurance policy validation
Effective problem resolution
Conflict resolution strategies
Experience
September 2017 - March 2025
Shelterpoint/Protective - Garden City, NY
Customer Service Representative
Provided exceptional customer service to ensure customer satisfaction.
Maintained a high level of professionalism when dealing with difficult customers.
Answered incoming calls and emails, providing frontline customer support or assistance with product and service transactions.
Asked probing questions to determine service needs and accurately input information into electronic systems.
Utilized job-related software to prepare change of address records and issue service discontinuance orders.
Answered customer inquiries and provided accurate information regarding products and services.
Increased customer satisfaction ratings by effectively answering questions, suggesting effective solutions, and resolving issues quickly.
September 2014 - April 2017
EmblemHealth - Melville, NY
Medical Management Specialist
Reviewed appeals submitted by members or providers for denied services or payments.
Resolved customer service issues in a timely manner while maintaining high levels of professionalism.
Ensured compliance with all regulatory requirements related to medical management activities.
Coordinated insurance eligibility verification, prior authorizations, referrals, and claims processing.
Developed and implemented medical management policies and procedures.
Compiled and coded patient data using standard classification systems.
Safeguarded medical records to maintain patient confidentiality.
Maintained accurate records of all medical management activities in accordance with applicable laws and regulations.
Answered questions and fulfilled requests with friendly and knowledgeable service.
Education and Training
May 1990
Quinnipiac University Hamden, CT
Bachelor of Arts Psychology
Activities and Honors
Captain Garden city Fire Department
EMT
Certifications
EMT basic
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