Customer Service Call Center

Clarissa Evans

+1-414-***-**** **********@*****.*** Milwaukee, WI 53208

WORK EXPERIENCE

Remote Customer Care Specialist I, Navitus Health Solutions - Madison, WI January 2023 - Present

• Understood, applied, and communicated client-specific prescription and pharmacy claim info in a primarily inbound call center environment.

• Entered overrides for pharmacy claims in backend.

• Troubleshooted pharmacy claims in real-time to verify information the pharmacy submits.

• Compared claim results to benefit rules.

• Entered approved overrides to allow claims to pay.

• Sent documents to providers and pharmacies electronically.

• Answered questions to prevent repeat calls, educated customers and reduced customer effort.

• Protected all personal health information and abode by all HIPAA regulations and confidentiality requirements.

• Adapted to fluctuations in workload from slower times to extremely busy times.

• Effectively worked/communicated with internal teams, such as, Prior Authorization and Manual Claims departments.

• Maintained scheduled hours and demonstrated flexibility to aid in coverage. Remote Customer Service Representative, Gainwell Technologies November 2021 - December 2022

• Worked from home fielding incoming calls from insurance policy holders as well as providers.

• Answered and resolve all inquiries from customers, providers, groups, agents, legal representatives and WPS personnel regarding benefits, eligibility, adjudication, payment or rejection of claims and/or billing questions.

• Established a rapport and tactfully and professionally assist with all contacts in a customer-focused environment to present a favorable corporate image.

• Preformed independently and efficiently and resolved the majority of inquiries with little assistance.

• Obtained and analyzed information to determine appropriate action required to respond effectively to inquiries.

• Researched claim adjudication inquiries which included analyzing claims data to determine the specific problem area including external communications to obtain data.

• Provided information to appropriate unit for correction, payment, etc as required.

• Conveyed disposition and resolution of inquiries to customers using various forms of communication within the time frames required to meet or exceed the respective performance metric.

• Collected and logged data for customer service/claims survey, customer service records, and computer analysis.

Insurance Document Associate, Northwestern Mutual

September 2020 - March 2022

I work as part of a team responsible for opening evaluating, acknowledging and distributing mail in support of an assigned business unit. I examine incoming mail to ensure it has reached the correct destination, re-routing any misdirected mail to the proper area. My duties include:

• Reviewing the work for high priority insurance, mail, and / or claim documents. Ability to recognize and identify misrouted forms and documents and routes them appropriately. Organizes the documents according to guidelines for the type of product. Identifies and classifies documents and includes generic or custom ID sheets with the document name. Prepares the documents for scanning by placing the documents and ID sheets in the correct order and determining the correct scan path. Responsible for meeting all established service level agreements.

• Electronically preps the documents by placing them in the correct order using established guidelines. Able to identify and handle documents with obvious modifications.

• Accurately and consistently scan documents while ensuring high image quality.

• Selecting and scanning using correct scan path; maintaining preventive cleaning on scanners; detecting scanning errors, double feeds and other quality issues; troubleshooting scanner problems.

• Re-scanning documents due to requests from business area or error messages; investigating and researching unidentifiable mail, including determining policy number / claim number and proper disposition for non-E-Files / DI Connection mail; handling original document requests from business area; audit/testing of documents to validate document classification and/or system enhancements/upgrades are accurate and properly functioning.

• Maintenance and shipping of documents to the Records Center

• Opening application, DI Benefits and/or post approval pouch mail

• Responding to basic inquiries for rescans and original documents

• LAN monitoring

• Handle confidential information in a manner consistent with privacy laws and regulations and Northwestern Mutual standards.

Optician, Wisconsin Vision

August 2018 - July 2020

Scheduling appointments, organizing doctor days, transposing ophthalmologist prescriptions, Zeiss product knowledge, taking proper Seg, P.D. and OC height measurements, reading glasses through lensometer, tracking lab orders, properly billing insurances, trouble shooting progressives with patients, answering phones, contact lens knowledge, maintaining cash register, keeping frames organized on frame boards organized, constantly maintaining a clean work environment, providing excellent customer service to patients, sales.

Part - time Software Applications Support & Office Assistant, Ancilla Partners January 2019 - November 2019

• Perform day-to-day support for our software applications to end-users.

• Receive and respond to phone calls and emails through our Help Desk tool.

• Update Help Desk tool with FAQ’s, information about new releases, and generally helpful knowledge regarding the applications.

• Document any issues and review with Manager to improve best practices.

• Assist managerial staff with various tasks.

• Gather data for Key Performance Indicators and metrics.

• Assist in testing new enhancements for our applications.

• Other ad-hoc tasks as deemed appropriate by Manager.

• Complete office-related duties.

• Answer phones, greet visitors, gather mail, keep kitchen and office spaces organized and tidy, maintain inventory of office supplies, etc.

Verification of Employment Specialist, THOUGHTFOCOUS August 2017 - March 2018

Verified employment history on behalf of national banks for mortgage loans. Placed out going calls daily.

Verified information provided by employers and banks. Handled sensitive materials such as social security and wage information discreetly. Maintained professional demeanor at all times.

Worked quickly to complete work orders in a timely fashion. Sent and sorted incoming emails from clients.

Stayed up-to-date with constant procedural changes. Cashier, Metcalfe 's Market

March 2013 - August 2017

Operated a cash register for cash, check and credit card transactions with 90% accuracy. Stocked and replenished merchandise according to store merchandising layouts. Cleaned and organized the store, including the checkout desk and displays. Completed all point of sale opening and closing procedures, including counting the contents of the cash register.

Educated customers about the brand to incite excitement about the company's mission and values. Cultivated a customer-focused shopping environment by greeting and responding to all customers in a friendly manner.

Maintained established merchandising standards, including window, sales floor and promotional displays.

Maintained a professional attitude at all times.

Priced merchandise, stocked shelves and took inventory of supplies. Seasonal Sortation Crew, Amazon

January 2017 - June 2017

53215***

Sorting packages based on size and destination.

Building pallets, wrapping pallets, transporting pallets with pallet jack, and sorting packages and pallets. Handled packages from small envelopes to boxes ranging up to 49 pounds and stood in one place for extended periods of time.

Operated carts, dollies, hand trucks and other moving equipment to move large quantities of merchandise.

Manually wrapping finished pallets.

Adhering to safety training and wearing high visibility vest at all times. EDUCATION

AVEDA Institute of Beauty and Wellness

2018-2021

Associate of Arts and Sciences - AAS, Cosmetology

Milwaukee Area Technical College

2009-2011

Associate, Computer Information Systems

SKILLS

Accuracy, Active Directory, Analysis, Answering Phones, Application Support, Applied Sciences, Assembly Line, Auto Detailing, Cashier, Computer Literacy, Conflict Management, Customer Service, Data Entry, Detail Oriented, Dolly, English Speaking, Fashion, Hand Cart, Help Desk Support, LAN, Managing Crews, Manicurist, Microsoft Excel, Microsoft Windows, MS Office, Multi Tasking, Multilingual, Pallet Jack, Pallet Jack Driver, Personal Shopping CERTIFICATION AND LICENSES

Licensed Manicurist

Nail Technician License in Manicuring

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