Customer Service Center Representative

DEKALA

GADSON

*************@*****.***

Tampa, FL 33602

Passionate about promoting lasting customer satisfaction by delivering quality service and unparalleled support. Proficient in customer service best practices and related options. Solid team player with outgoing, positive demeanor and proven skills in establishing rapport with clients. Motivated to maintain customer satisfaction and contribute to company success. Specialize in quality, speed and process optimization. PROFESSIONAL SUMMARY

Humana - Claims Benefit Specialist

WFH • 06/2023 - Current

Maximus - Contact Center Representative (Claims)

Remote • 11/2019 - 05/2023

HealthPlan Services - Insurance Reimbursement Specialist Tampa, FL • 04/2016 - 11/2016

WORK HISTORY

Resolved complex claims issues for improved customer satisfaction and reduced claim backlog.

•

Collaborated with medical professionals to obtain accurate information for proper benefit determination.

•

Developed strong relationships with healthcare providers and insurance agents to facilitate seamless communication during the claims process.

•

Maintained up-to-date knowledge on industry regulations and guidelines, ensuring compliance throughout the claims process.

•

Understood requirements for disputes, gathered evidence to support claims and prepared customer cases to handle appeals.

•

Improved customer satisfaction by efficiently addressing and resolving issues in a timely manner.

•

Provided exceptional customer service by actively listening to inquiries and offering personalized solutions.

•

Managed high call volume while remaining focused on delivering excellent customer experiences.

•

Reduced handle time by quickly identifying customer needs and providing accurate information.

•

Streamlined internal communication processes between departments for more efficient collaboration during claim investigations.

•

Achieved timely reimbursements for clients through diligent follow-ups with insurance carriers.

•

Increased client satisfaction with comprehensive claim review, ensuring accuracy and compliance with policy guidelines.

•

Expedited resolution of disputed claims by skillfully negotiating settlements between clients and insurance providers.

•

Ensured compliance with HIPAA regulations while managing sensitive patient information during the reimbursement process.

•

• Collaborated with healthcare providers to obtain necessary medical SKILLS

• Data Entry

• Teamwork and Collaboration

• Small Claims Payouts

• Documentation abilities

• Eligibility Determination

• Payment Processing

• Call Center Operations

• Written and oral communication

• Customer Support

• Inbound/Outbound Calling

• CRM Navigation

• Customer Service

• Coverage assessments

• Documentation Review

• Claims analysis

• Benefits Administration

Newsome High School

Lithia, FL • 01/2014

High School Diploma

EDUCATION

General Dynamics IT - Customer Care Coordinator

Riverview, FL • 09/2015 - 03/2016

records for prompt claim adjudication.

Minimized denials by conducting thorough pre-authorizations prior to submitting claims for payment consideration.

•

Collaborated with healthcare providers to ensure accurate and complete referral information, improving patient care coordination.

•

Enhanced communication between healthcare providers and insurance companies, ensuring prompt resolution of issues related to prior authorizations.

•

Contributed to a high level of customer service by quickly addressing questions or concerns from patients regarding their coverage or denials.

•

Coordinated with billing department to resolve discrepancies related to denied claims due to incomplete or incorrect prior authorizations.

•

Verified eligibility and compliance with authorization requirements for service providers.

•

Available Upon Request

REFERENCES

Contact this candidate