Customer Service Live Chat
Resume:
Summary
Customer Service Representative with *+ years of high-volume call center experience, specializing in inbound and outbound inquiries across healthcare and insurance sectors. Skilled in navigating complex systems, resolving billing and claim issues, and supporting multi-channel communications (phone, email, and web). Strong remote work ethic with reliable internet connection and proficiency in Microsoft Office, CRM platforms, and medical billing codes (ICD-10, CPT, HCPC). Proven ability to adapt to shifting business needs and schedules, including weekend and holiday availability Key Strengths
Clear written & verbal communication
Time & task management
Tech-savvy (Zoom, Google Workspace, CRM)
Customer support & conflict resolution
Adaptable & self-directed
Digital organization & accurate data entry
Remote collaboration
Experience
Member Services Rep
Ibex/DentaQuest • W@H 05/2025 - Present
Responded promptly and professionally to member inquiries regarding dental coverage, claims, benefits, and eligibility.
Assisted members with plan enrollment, changes, and renewals, ensuring accuracy and compliance with company policies.
Investigated and resolved claim issues, coordinating with providers and internal departments to facilitate timely payments.
Educated members on their dental benefits, explaining plan details clearly to promote informed decision-making. Maintained detailed and accurate records of member interactions and transactions in the CRM system. Identified opportunities to enhance member satisfaction and retention by providing personalized support and solutions.
Collaborated with dental providers and claims departments to address member concerns and improve service delivery.
Followed regulatory guidelines and company procedures to ensure compliance and protect member privacy. Health Plan Specialist
Medica • Madison, WI 12/2024 - 02/2025
Key Responsibilities:
Answer inquiries on coverage, premiums, deductibles, and eligibility. Process requests for policy changes, updates, and plan selections. Assist with claims by explaining denials and appeals. Provide pre-authorization for medical procedures.
Manage accounts by updating information and resolving billing issues. Explain benefits and complex insurance terms.
Resolve complaints and find solutions to customer concerns. Cross-sell/upsell relevant insurance products.
Jessica Ramey
*************@*****.***
Shawnee, OK
Ensure compliance with HIPAA and industry regulations. Stay updated on policy and industry changes.
Researched and communication effectively HCPC, ICD-10, and CPT billing codes to members and providers who had questions regarding their diagnosis and treatment Customer Service Representative
Everise • W@H 01/2021 - 08/2024
Resolved customer inquiries and provided guidance on a range of healthcare plans and services to improve satisfaction and retention.
Maintained accurate patient and client records while delivering personalized solutions to meet diverse healthcare needs.
Collaborated with team members to develop a comprehensive healthcare knowledge base, boosting efficiency and consistency.
Led initiatives to improve service processes, reducing response times and enhancing overall patient experience. Analyzed customer feedback to identify trends and tailor healthcare plan recommendations accordingly. Managed complex healthcare-related issues with effective resolutions, fostering loyalty and high satisfaction ratings.
Education
High school or equivalent
Harrah High School • Harrah 05/2008
Skills
Customer service, Computer literacy, Time management, Communication skills, Microsoft word, Written Communication, Verbal Communication, Time Management, Task Management, Tech Savvy (Zoom, Teams, G Suite, CRM), Customer Support and conflict resolution, Adaptable and self directed, Digital Origination & accurate data entry, Remote Collaboration, Excel, Word, Outlook, Microsoft Office, Salesforce, Software Troubleshooting, Desktop Support, Technical Support, Cash Handling, Telephone Skills, Insurance Sales, Typing Certificates
Insurance Producer License, Driver's License
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