Customer Service Data Entry

Gail House

Houston, TX ***** 832-***-**** ****.********@*****.***

Career Profile

Experienced and reliable customer service representative with extensive experience helping in Managed Healthcare environment. Strong dedication to help providers and clients resolve issues and cultivate a positive image of the company. Excel in both team environments and alone. Proven ability to listen attentively, solve problems quickly and efficiently, and create high-quality professional relationships with providers and clients.

Core competencies include Data Management, billing, research, problem resolution, Microsoft Office/Excel, contracts, team support / Ad-Hoc, planning & organizing, high-level administrative, payroll, sales/new business.

Experience

Medical Bill Coordinator 09/2019 to Current

Sedgwick, LLC

• Gather comprehensive documentation from varied internal and external sources

relevant to issue raised in grievance/appeals.

•Process correspondence to appealing party, timely and in accordance with federal/state regulations and established policies for all lines of business.

•Provide superior customer service to internal staff, members, and providers in answering inquiries, gathering complaint information, or providing education.

•Effectively use critical thinking to investigate and correctly categorize cases and determine a course of review action and parties to contact.

•Accurately identify the different types of complaints.

•Effectively completed data entry for tracking and reporting of claim disputes.

•Communicated resolution to appropriate parties.

•Increased customer satisfaction by resolving grievance/appeals. Lowering the ratio to 40% within the first quarter.

•Use company troubleshooting resolution tree to evaluate technical problems while leveraging personal expertise to find appropriate solutions.

•Train new hires and transition team members across multiple business units as needed to promote cross collaboration and skill sets.

Data Management 5/2012 - 9/2019

Rockport Healthcare Group

•Verified and corrected discrepancies in provider data, improving data accuracy by 50% within the first quarter.

•Entered PPO provider contracts into Access 97 system with an accuracy rate of 95.9%.

•Effectively handled urgent data entry requests, ensuring a turnaround time of under 24 hours for high-priority tasks.

•Executed data entry tasks 22% faster than team average.

•Conduct regular data audits and resolve discrepancies.

•Collaborate with team members to ensure data-related tasks align with business objectives.

•Adhere to organizational policies and compliance regulations regarding data privacy and security.

Front Office Receptionist 3/2006 - 5/2012

Rockport Healthcare Group

•Greeted visitors, answered phones, and directed inquiries to the appropriate staff member.

•Maintained a professional and friendly atmosphere in the reception area.

•Effectively managed incoming and outgoing mail and packages.

•Scheduled and coordinated meetings and appointments.

•Assisted with administrative tasks such as filing, photocopying and scanning.

•Crossed trained with other departments as needed.

•Assisted with special projects as needed.

•Ensure accurate and timely pricing communication to customers, distributors and sales representatives.

•Managed over 60 customer calls per day, increasing sales by 20%.

•Maximized customer service satisfaction by assessing customer needs and aligning product offering with customer goals.

Education

Bachelor of Science: Health Administration

University of Phoenix - Tempe, AZ

Volunteer Work

Volunteer Group Leader Assistant for the after-school enrichment program at SHAPE Community Center - 1995-1996

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