Customer Service Representative

Shameka Crennel

****************@*****.*** 804-***-**** Petersburg, VA

SUMMARY

Seasoned professional with years of experience in customer service within healthcare settings, seeking a Healthcare Representative role. Skilled in member service, benefits education, and claims adjudication, with a proven track record of meeting key performance indicators. Holds a Bachelor's in Healthcare Administration/Management, adept at multi-tasking and maintaining high levels of member satisfaction. WORK EXPERIENCE

Point32Health

Member Service Representative Nov 2022 - Present

• Respond to and manage a high volume of inbound calls, providing effective resolution to member inquiries while maintaining detailed documentation of each interaction.

• Utilize probing techniques and educational opportunities to minimize repeat member calls, enhancing overall service efficiency.

• Conduct in-depth investigations and initial interventions for member complaints, ensuring thorough analysis and resolution of issues.

• Maintain adherence to key performance indicators and scheduled shifts to ensure consistent availability for member support, while demonstrating exceptional communication and active listening skills. Alorica/Express Scripts Niles, OH

Customer Service Representative Jun 2022 - Nov 2022

• Educated patients on home delivery benefits, enhancing their understanding of the service to align with lifestyle needs.

• Researched and resolved benefits coverage issues in collaboration with pharmacists and doctors' offices, offering patients informed guidance on medication access.

• Managed concurrent tasks effectively, ensuring meticulous documentation of interactions and prior authorization processes for providers and patients.

WPS Health Solutions Hampton, VA

Customer Service Representative Mar 2022 - Apr 2022

• Addressed and resolved inquiries regarding healthcare coverage, benefits, and claims for a diverse range of stakeholders, ensuring accurate application of healthcare regulations and policies.

• Analyzed and processed claims data, identifying and addressing specific issues, and coordinated external communications to gather necessary information for resolution.

• Guided healthcare providers on proper billing procedures to minimize errors and streamline claims processing, enhancing overall efficiency.

• Maintained a professional demeanor in all interactions, effectively communicating with clients through multiple channels to meet and exceed service level agreements. Integrated Resources Inc Edison, NJ

Eligibility Specialist/Counselor Apr 2021 - Feb 2022

• Assessed Medicaid applications for compliance and accuracy, ensuring adherence to eligibility requirements and processing determinations within mandated deadlines.

• Compiled documentation, entered data, and calculated applicant income to formulate recommendations on the continuation, cancellation, or modification of active Medicaid cases.

• Maintained timely and effective communication by addressing phone, written, and electronic inquiries, fulfilling all performance standards and objectives.

Crennel Household Hopewell, VA

Homemaker May 2009 - Apr 2021

• Streamlined daily operations through meticulous housekeeping and home management, ensuring a well-organized and efficiently run living environment.

• Coordinated a comprehensive scheduling system, aligning family activities and obligations to promote harmony and punctuality.

• Administered household finances with diligence, including budget formulation and execution, as well as timely bill payments, contributing to a stable financial structure. McDonald's Hopewell, VA

Crew Member/CSR Jun 2008 - Nov 2008

• Efficiently handled payment transactions, ensuring accurate processing of both cash and credit purchases while delivering prompt service in order fulfillment.

• Maintained rigorous standards of cleanliness and safety across multiple areas, complemented by professional and friendly customer interactions to enhance service quality. EDUCATION

University of Phoenix-Online Campus

Bachelor's in Healthcare Administration/Management April 2013 to July 2015

SKILLS

Internet & Computer Skills • Organizational Skills • Time Management • Strategic Planning • Logistics • Forecasting

• Maintenance • Budgeting • Cash Management • Housekeeping • Customer Service • Written and Verbal Communication • Training • Microsoft Office • Computer Networking • Typing • Document Review (Less Than 1 Year) • Windows • Customer Support • Medicare • Communication Skills • Computer Skills • Data Entry • Claims Processing • Prior Authorization • Provider Certification • Hipaa • Insurance Verification • Documentation Review • Hipaa • Research • Workday • Customer Service • Databases • Microsoft Word • Microsoft Excel • Microsoft Outlook

• Medical Records • Records Management • Typing • Analysis Skills

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