Customer Service & Eligibility Specialist Resume Title: Customer

Sharma Valkenburgh

Eustis, FL

Professional Summary:

• Dedicated and results-driven Customer Service Representative with a proven track record of delivering exceptional service in fast-paced environments.

• Adept at managing inbound and outbound calls with a focus on providing accurate information, resolving issues, and ensuring customer satisfaction.

• Experienced in utilizing communication platforms such as MS Teams, Zoom, and Skype, along with proficiency in Microsoft Office applications.

• Recognized for expertise in coordinating patient care, scheduling appointments, and navigating complex healthcare insurance processes.

• Seeking a challenging position to leverage my skills and contribute to a dynamic team. Education:

• High School Diploma

Oak Ridge High School, Orlando, Florida

Skills

• Inbound and outbound calling Customer relations (approx. 75-90)

• Communication Platforms-MS Teams, Zoom, Skype.

• Eligibility Representative

• Customer Service

• Microsoft Office Applications-MS Word, MS Excel, MS PowerPoint, MS Outlook. Work Experience :

Gap: Seeking Employment.

Customer Service Representative/ Eligibility Representative Cigna Insurance (Spectraforce) Apr 2023-Aug 2023

• Conducted inbound and outbound calls (approx. 75-90) to healthcare clients regarding scheduling appointments for specific health needs for Cigna Health Insurance.

• Coordinate patient care by scheduling orders, communicating information to the patient regarding shipments, assessing supply needs, verifying patient information, benefits, eligibility, and claims notifying the pharmacist of issues or changes in the patient’s condition.

• Provide correct information or directs the call to the appropriate team member or department while maintaining a high level of professionalism; ensure excellent patient relations are maintained and patient claims and complaints are resolved fairly and effectively.

• Proficient in managing conversational flow and diffusing difficult customer situations, handling customer needs escalations.

• Create patient activities as a reminder for the following tasks including but not limited to follow-up calls for patients, to initiate discharge of service, to contact a patient's doctor's office, to mail a letter to a patient, and any other reminders necessary as it relates to a patient's care.

• Provide typed documentation of all communications received from calls and provide notification of any urgent orders, shipping related issues and any errors, complaints or compliments to the appropriate party or system.

• Provide timely response to patients’ inquiries by telephone outbound service center, consistent with service and quality standards.

• Record and process orders and/or inquiries received by telephone. Customer Service Representative

Direct Interactions (Randstad) Jun 2021-Apr 2023

• Colorado Unemployment account.

• Investigate and problem solve for patients experiencing escalated issues such as disadvantaged or complex access, savings card/copay card challenges or non-preferred formulary issues. Where necessary, complete a healthcare benefit investigation, contact the HCP and/or patient or potentially the filling pharmacy or payor.

• Documents information in the appropriate system of record and formats. Accurately communicate insurance details to HCP and patients via phone, other electronic communication methods and fax, as per established policies and procedures.

• Provide subject matter expertise and best-in-class customer service for all inbound and outbound customer calls to drive first call resolution. Provide insurance coverage, verification details prior authorization statues and alternate funding options for existing and newly launched products.

• Assisted clients with questions regarding their unemployment benefits.

• Helped clients complete their applications.

• Explained guidelines and how the process works.

• Problem solving with payments.

Gap: Seeking Employment.

Customer Service Representative

Abns group LLC (Randstad) Sept 2020-Apr 2021

• Assisted approximately 50 customers each day with Non-Emergency Medical Transportation Reservations.

• Asked probing questions to determine service needs and accurately input information into electronic systems.

• Upheld privacy and security requirements established by State regulatory agencies. Gap: Relocated.

Customer Service Representative

SITEL, Ocala, FL Apr 2016-Mar 2018

• Informed customers about billing procedures, processed payments and provided payment option setup assistance.

• De-escalated problematic customer concerns, maintaining calm, friendly demeanour.

• Delivered service and support to each customer, paving way for future business opportunities. Gap: Seeking Employment.

Customer Service Representative

Ansafone Contact Centers Jan 2014-Nov 2014

• Assisted approximately 90 customers each day with Healthcare Provider questions.

• Asked probing questions to determine service needs and accurately input information into electronic systems.

• Informed customers about billing procedures, processed payments and provided payment option setup assistance.

• Evaluated customer account information to assess current issues and determine potential solutions.

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