Customer Service Verification Specialist
Resume:
Dorothy Williams
Lakeland, FL *****
********************@*****.***
Professional Summary
Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Willing to relocate to: Tampa, FL
Work Experience
Benefits Verification Specialist
TEKsystems-Tampa, FL
June 2024 to Present
I work with insurance insurance and pharmaceutical companies to:
• Confirm the patient's insurance plan, coverage details, and any limitations on specific procedures or services.
• Interact with insurance providers to obtain information, request prior authorizations, and resolve billing issues.
• Documenting and Maintaining Records by accurately recording patients coverage details, insurance information, and any related communications.
• Provide guidance to patients regarding their coverage, out-of-pocket costs, and how to navigate their insurance benefits.
• Review work for accuracy and identify any trends or delays in reimbursement.
• Completed tasks like coding, billing, and claims examinations.
• Often collaborate with other healthcare professionals, such as patient intake coordinatorsn case managers, patient assistance programs and billing staff. Tax Preparer
Self-Employeed-Tampa, FL
January 2022 to Present
• I met with clients
• Prepared and filed tax returns
• Advised against potential tax liabilities
• Examined financial records
• Tax planning and strategy development
• Calculated tax payments
• Tax credit and deduction maximization
• Provided exceptional customer service
• Tax compliance advice
• Audited returns for accuracy and compliance
• Estimated and track tax returns
• Filed tax returns for clients
• Other duties as needed
• Presented approved returns to clients
• Resolved customer complaints
• Uncovered potential deductions and credits
• Utilized tax preparation and bookkeeping software
• Verified the accuracy of records
Medicare Sales Agent
GetHealth-e-Tampa, FL
August 2023 to March 2024
• Developed and implemented sales strategies to increase Medicare enrollment.
• Conducted extensive market research to identify potential customers.
• Analyzed customer data and identified trends in the Medicare market.
• Product information and answered questions about Medicare services.
• Coordinated events, seminars, and workshops to promote Medicare products.
• Negotiated contracts with health care providers for coverage of Medicare services.
• Managed a team of Sales Agents to ensure goals were met or exceeded.
• Resolved customer complaints quickly and professionally. Insurance Claims Specialist
Together Health Network-Clearwater, FL
August 2022 to August 2023
• Reviewed customer insurance claims to ensure accuracy and completeness of information.
• Analyzed claim records, policy provisions, and other relevant documents to determine validity of claims.
• Assisted customers in filing new insurance claims and provided status updates on existing ones.
• Investigated suspicious or fraudulent claims and reported findings to management.
• Resolved customer complaints related to insurance claim processing.
• Collaborated with team members to identify trends in customer issues and develop solutions accordingly.
• Maintained detailed records of all claim activities including correspondence, decisions, payments.
• Advised customers on how they can protect themselves from potential risks associated with their policies.
• Ensured compliance with state laws governing insurance practices as well as company policies and procedures.
Pharmacy Service Representative
CVS Specialty Pharmacy-Tampa, FL
February 2018 to August 2022
• Developed policies and procedures relating to pharmacy services delivery processes.
• Provided excellent customer service to patients and healthcare providers while answering inquiries, resolving complaints, and processing orders.
• Researched drug information by consulting references such as the Physicians' Desk
• Verified accuracy of prescriptions with physicians when necessary.
• Maintained patient profiles, including demographics, insurance coverage, and medication history.
• Assisted pharmacists in filling prescriptions accurately and efficiently.
• Processed incoming and outgoing calls regarding prescription refills, adverse reactions to medications, or medical problems related to drugs.
Implementation Specialist
CoAdvantage-Tampa, FL
February 2017 to February 2018
• Provided customer service phone inquiries from clients, employees & carrier contacts.
• Answered benefit questions, resolved problems related to access or payment of benefits
• Completed orientation of newly eligible employees.
• Provided online medical, prescription & dental data entry with applicable carriers.
• Audited benefit enrollments & processes both client & employee adjustments as necessary.
• Responsible for complying with government regulations relative to benefit enrollments & relative to payroll processing.
• Responsible for auditing all aspects of payroll, benefits and employee data to ensure accuracy.
• Responsible for setting up new Clients accurately and timely in company systems.
• Fostered strong relationships across departments.
• Conducted end user training, database administration, and web server configuration as the software back-end subject matter expert
• Maintauned quality control of client system.
• Assisted with client and employee questions received through meetings, emails, or phone calls regarding onboarding documents, payroll.
• Managed the electronic data entry of onboarding process and new hire paperwork for all employees and new hires.
• Participated in virtual meetings with client throughout the project cycle and into support.
• Designed a web base tool (CoAd360) to support new employees during system training for all Clients. Education
Trade school in Accounting
D G Erwin Technical Center-Tampa, FL
January 2009 to September 2009
High school diploma
East Bay High School-Gibsonton, FL
August 1998 to May 2002
Skills
• Customer service
• Accounting
• Business requirements
• Organizational skills
• Microsoft Office
• Microsoft Excel
Certifications and Licenses
Health Insurance License
August 2022 to Present
W786273
Certified Notary Public
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