Customer Service Specialist with Insurance Experience

Destanie Gilford

Calera, OK ***** • +1-903-***-**** • *****************@*****.*** • WWW: Bold Profile Skills

• Customer service • Problem-solving

• Active listening • Adaptability and flexibility

• Data entry • Computer proficiency

• Problem resolution • Critical thinking

• Call center experience

Professional summary

Committed to ensuring customer satisfaction by providing exceptional service and unmatched support. Proficient in utilizing customer service best practices and adept at exploring different solutions to address customer needs effectively.

EXPERIENCE

Customer Service Representative, 07/2024 to Current Express Scripts – Remote

• Resolved customer complaints with empathy, resulting in increased loyalty and repeat business. Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.

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Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.

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Enhanced customer satisfaction by promptly addressing concerns and providing accurate information.

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Developed rapport with customers through active listening skills, leading to higher retention rates and positive feedback from clients.

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Insurance Verifier, 02/2023 to 07/2024

Texoma Medical Center – Denison, Texas

• Verify insurance eligibility and coverage for patients

• Monitor and update insurance information in the system

• Communicate with insurance providers to obtain required information Developed a working knowledge of insurance plans, including Medicare and Medicaid regulations and requirements.

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• Provided timely follow up with payers regarding payment status of claims. Identified discrepancies in patient's insurance coverage or benefits, ensuring accuracy of data entered into system.

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Researched third party payer guidelines related to prior authorizations, coding and billing processes.

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• Responded promptly to customer inquiries regarding their benefits and eligibility status. Collaborated with internal staff members such as Billing Specialists, Medical Coders, to resolve any discrepancies in patient's insurance information.

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Medical Office Specialist, 12/2021 to 02/2023

TexomaCare – Denison, TX

Sending/receiving patient medical records; obtaining lab/x-ray reports, hospital notes, referral information, etc; completing forms/requisitions as needed; scheduling appointments

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• Input all patient data regarding claims and prior authorizations into system accurately Verifying insurance coverage and patient demographics; managing charts to ensure information is completed and accurate

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Processed medical records requests from outside providers according to facility, state and federal law

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• Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures

• Communicated effectively with staff, patients and insurance companies by email and telephone Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations

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• Reached out to insurance carriers to obtain prior authorization for testing and procedures

• Received, recorded and filed medical payments by check, cash and credit card Front Desk Receptionist, 12/2018 to 12/2021

Premier Pulmonary & Sleep Medicine – Denison, TX

Schedule surgeries by making arrangements with the surgical center, verifying times with patients and preparing charts/orders

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• Answering emergency calls and direct patients to the proper physician for care in a timely manner

• Collecting insurance copays, deductibles, and balances at the time of the patient's appointment Processing staff and patient incoming calls, faxes and inquiries, including incoming/outgoing referrals

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Taking patient's messages, providing directions/instructions to the patients according to physician orders and treatments

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• Record and update patient information, managing scheduling follow ups and medication refills Collect past due balances, room patients, review past medical and surgical history, proficient in the utilization of electronic medical records, and managing clinical calls and emails throughout the day

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Medical Records Clerk, 09/2015 to 12/2018

Texoma Neurology Associates – Sherman, TX

• Performed clerical tasks such as filing, faxing, mailing, sorting through emails throughout the day

• Maintained accuracy, completeness and security for medical records and health information

• Retrieved and prepares charts for following day appointments

• Released information to persons or agencies according to regulations

• Retrieved and requested patient medical records for physicians, technicians and staff

• Insured patients charts was ready for appointments

• Prepared reports for state auditing of medical charts

• Input data into computer programs and filing systems

• Above-average file auditing skills

• Kept accurate log of all requests for medical information and records EDUCATION

High School: 01/2013

Denison High School - Denison, TX

No Degree: Business Administration And Management, Expected in 12/2026 Grayson College - Denison, TX

References

References available upon request

Contact this candidate