Customer Service High School

Resume of: Duana Mender

Candidate Location (City/State): Columbia SC, 29203

Onsite/Remote/Partially Onsite (if partially onsite, how many days per week/month): Onsite

Candidate Phone Number: 803-***-****

Candidate email address: *****.******@*****.***

Previous FTE/Contractor (Yes/No – specify which one applies): YES

Cleared for Rehire per MSP (Yes/No – only applies for FTE rehires): YES

Previous Client Hiring Manager (if applicable): N/A

Highest Level/Form of Education Completed: High School Diploma

Licenses and Certifications held (when applicable for the position): N/A

Provide the total number of months of relevant work experience: 60+ months

Salary Requirements: $25.00/hr. on W2

Planned time off: No

Summary of the candidate:

Over 9 years of experience in customer Service Rep role with including direct customer service at Seib Insurance & Apple One. Skilled in call handling, data entry, and demographic analysis. Proficient in database management and Excel, with a strong background in healthcare-related customer support.

Detailed oriented. Responsible. Enthusiastic and a self-starter. Possess a strong work ethic. Get along well with others.

Ability to help customers in a professional and concerned manner with excellent service and customer satisfaction.

Handled high volume inbound and outbound calls up to 70 to 80 calls on daily basis.

Possesses the ability to work creatively and effectively with staff members while providing detailed documentation and resolutions.

Able to represent my company with dignity and professionalism while adhering to privacy and client confidentiality.

Can be trusted to handle complaints diplomatically and efficiently while showing commitment to professional growth and development.

Attains excellent writing, communication and organizational skills; very detailed oriented and skilled in setting priorities.

Skills

Problem Solving

Product Knowledge

Communication

Active Listening

Conflict Resolution

Empathy

Time Management

Adaptability

Education

High School Diploma, Dreher High School Columbia SC - 1982

Work Experience

Novitas Solutions Columbia SC Oct 2023 – Dec 2024

Provider Service Advocate

Handled high volume inbound and outbound calls up to 70 to 80 calls on daily basis.

Claims Support and Resolution: Act as the primary point of contact for healthcare providers, assisting them with the submission, processing, and resolution of claims, ensuring timely and accurate reimbursement.

Provider Education and Training: Educate and train healthcare providers on policies, procedures, and Medicare billing guidelines to ensure compliance with regulations and optimize payment accuracy.

Issue Identification and Problem Solving: Investigate and resolve inquiries, discrepancies, or issues related to claims, billing, coding, and coverage, providing guidance to ensure provider satisfaction.

Communication and Collaboration: Foster strong relationships with healthcare providers through clear and effective communication, addressing concerns, offering solutions, and ensuring their needs are met in accordance with company policies.

Regulatory Compliance: Stay up-to-date with Medicare and other regulatory guidelines, ensuring that all provider interactions and claims processing are compliant with relevant laws and standards.

Palmetto GBA, Columbia, SC Nov 2021 - Oct 2023

Analyst

Conducted in-depth data analysis to support business operations and decision-making processes at Palmetto GBA, utilizing advanced analytical tools to interpret complex datasets and deliver strategic insights.

Data Analysis and Reporting: Conduct thorough analysis of healthcare data, including claims and billing information, to identify trends, anomalies, and areas for process improvement, providing actionable insights to management.

Claims Processing and Review: Review and process Medicare claims, ensuring compliance with regulatory standards, accurate coding, and appropriate reimbursement, while addressing issues related to claim discrepancies or denials.

Policy Interpretation and Guidance: Interpret and apply Medicare policies, procedures, and guidelines to assist providers and internal teams, ensuring accurate and compliant billing practices.

Process Improvement Initiatives: Collaborate with cross-functional teams to identify and implement process improvements aimed at enhancing operational efficiency, reducing errors, and improving provider satisfaction.

Stakeholder Communication and Support: Serve as a liaison between Palmetto GBA and healthcare providers, offering guidance on claims issues, program changes, and other operational concerns through effective communication and problem-solving.

Blue Cross Blue Shield of South Carolina, Columbia, SC Dec 2015 – Nov 2021

Data Prep Tech II

Perform comprehensive data preparation tasks, ensuring accurate processing and integration of client data into Blue Cross Blue Shield of South Carolina's systems, while adhering to strict confidentiality and compliance standards.

Handled high volume inbound and outbound calls up to 40 to 50 calls on daily basis.

Customer Service Support: Provide responsive customer service to both internal teams and external members, addressing inquiries, resolving issues, and offering guidance on claims, benefits, and account details.

Issue Resolution and Troubleshooting: Investigate and resolve data discrepancies, billing issues, or technical errors, working to ensure timely and accurate resolution while maintaining high levels of customer satisfaction.

Collaboration and Communication: Coordinate with cross-functional teams such as IT, operations, and claims departments to resolve data-related issues, ensuring seamless service delivery and operational efficiency.

Seib Insurance & Reinsurance Company LLC/Apple One, Columbia SC Oct 2015 - Oct 2015

Customer Service

Managed high volumes of inbound calls to address customer inquiries and record demographic information and claim details.

Handled high volume inbound and outbound calls up to 70 to 80 calls on daily basis.

Ensured accurate data entry for seamless claims processing and customer record maintenance.

SCDHHS Columbia SC Jul 2014 - Sep 2015

Office Assistant

Processed Medicaid telephone applications by registering new applicants and ensuring accurate demographic entry in the IBM Curam Access Database.

Matched and attached audio signature files to corresponding applicant profiles to facilitate further processing by relevant county or department.

Conducted research and compiled reports using Excel to support management decision-making processes.

SCDHHS Columbia SC

October 2012- May 2014

Scanner Imaged Medicaid applications and supporting documents.

Special Project Data entered demographics from Medicaid applications

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