Customer Service Representative
Resume:
Keisha Hall-Gregory
************@*****.***
Professional Summary: Experienced Provider and Customer Service Representative with 19 years of industry experience. Proven track record of successfully managing providers and members concerns and great teamwork skills. CAREER HISTORY
Resource Planning Associate Representative
Cigna Thru Magnet-Redford, MI
September 2024 to Present
● Place and take inbound and outbound calls daily from members.
● “Sell” the assessment to members, well visits, postpartum as well as well child visits with a Nurse
● Practitioner
● Communicate effectively with departments via email about providers scheduling statues, leads to
● call and daily assignments
● Act as a primary point of contact with assigned providers
● Access several insurance portals to verify members insurance
● Use scheduling software to schedule appointments for providers, update patients demographics.
● document calls made to members
Contact Center Advocate (Remote)
Henry Ford Health System-Detroit, MI
January 2022 to May 2024
● Operate computerized program to schedule, reschedule and cancel appointments requests using electronic patient scheduling system.
● Respond to incoming and outgoing calls using internal computer hardware and software health record,
● within secured health care compliance.
● Interpret and verify patient eligibility according to privacy and security compliance.
● Specialty Scheduling using Book using knowledge of health care processes.
● Provide information and concerns to administration and supervisors for appropriate resolutions for
challenging or urgent calls.
● Provide high quality customer service to patients and their families with knowledge of the jobs core values.
● Use knowledge of health care process when scheduling appointments, giving accurate information.
● Enter No-Show information, monitor and update patient appointment data into electronic system.
● Maintain professional integrity with secure information in all formats.
● Process prescriptions and billing. Contact physician offices, Relay calls to other departments
Member Benefits Representative for Medicaid
Meridian Health Plan-Detroit, MI
October 2019 to September 2021
● Took incoming calls and emails from Medicaid patients to conduct and evaluate individual healthcare
● concerns and benefits.
● Reviewed insurance benefits on behalf of the members and the company.
● Interpreted and verified patient eligibility on computer software system
● Maintain professional integrity with secure information in multiple formats.
● Responsible for customer retention by proactively engaging current members through interviews.· Consulted with members upon renewal to determine the best plan for their individual needs.
Benefits Specialist. Claims Analyst
Health Alliance Plan (contracted through Aerotek0-Detroit, MI December 2017 to May 2018
● Answered provider inquiries regarding verification of benefits and claims status.
● Prepared and resolved written responses to incoming provider reconsideration requests for payment.
● Verified members benefits and investigated disputed claims.
● Provided exceptional customer service to all clients.
● Entered precertification claims into claims processing system.
● Maintained and processed miscellaneous healthcare claim queues to completion.
● Reviewed claims spreadsheets and plan documents. Processed Pharmacy Claims.
Automotive Claims Analyst
Concentrex-Southfield, MI
● Process vehicle repurchase claims for clients via phone, emails and documents.
● Address client’s complaints and concerns regarding vehicle issues.
● Review, Monitor and Interpret client’s vehicle finance Contracts.
● Interpret and relay State Lemon Law guidelines to Clients and dealerships.
● Complete State mandated documentation for Vehicles for compliance.
● Process, approve or deny claims in accordance with OEM program guidelines ensuring compliance and security.
● Access and update secured and sensitive data in internal and external databases.
● Problem solve for client issues with high level of professionalism and knowledge, while maintaining compliance standards and guidelines.
● Resolve assigned claims to completion to close cases.
● Work with other internal departments to ensure program success. Education
Associate of Arts Degree
Henry Ford Community College - Dearborn, MI
Skills
EMR systems, HIPAA, Medical Billing, Scheduling, Insurance Verification, CRM software,
Contact this candidate