Customer Service & Eligibility Specialist
Resume:
Sandy Boun
Signal Hill, CA *****
*****.****.**@*****.***
Professional Summary
To obtain a dynamic position where I can enhance and apply my customer service skills, build strong client relationships, and consistently meet or exceed performance goals, while contributing to the overall success of the organization and pursuing continuous professional growth and long-term career advancement.
Work Experience
Eligibility Coordinator
SCAN Health Plan-Long Beach-CA
December 2024 to Present
Eligibility Coordinator (Temp)
SCAN Health Plan-Long Beach, CA
August 2024 to December 2024
• Processes member applications by reviewing data for deficiencies; assigning codes to data; establishing data entry priorities and resolving discrepancies by using departmental policies and procedures.
• Enter member data by inputting alphabetic and numeric information into IKA system according to screen format including benefit assignment, group affiliation, and provider selection, billing information, revenue codes and appropriate cross references.
• Verify eligibility for enrollment using state and federal websites.
• Provide excellent customer service by making a high volume of outbound calls to members to clarify, obtain, and or confirm information needed to successfully complete member’s enrollment request.
• The ability to accurately interpret and explain eligibility and CMS regulations and requirements in person, via email or telephonically.
• Complete requests received through Enterprise, Department Inbox, and Department Queue by responding appropriately and in a timely fashion to internal and external customers; by answering telephonic and written inquiries concerning eligibility issues; following department policies and procedures; by professionally representing the department to others.
• Prepare eligibility report mailings by generating, reviewing and distributing eligibility information to providers within defined timelines.
• Prepare member correspondence by creating, triggering, printing, reviewing and mailing.
• Assure accurate data from regulatory system reply by utilizing federal systems and other departmental systems to run reports and collect and analyze data for any necessary updates.
• Responsible for daily reconciliations, to resolve member eligibility Issues by analyzing, correcting or updating data received on daily claims error report, unassigned PCP list and Incomplete Queue.
• Reconcile discrepancies between member data and various systems.
• Research eligibility rejected transactions by identifying discrepancies and reporting findings to the appropriate business area.
• Ensure regulatory compliance by following departmental desktops, policies and procedures, by adhering to state and federal regulations and requirements.
• Assist co-workers by training, updating processes, and assisting with job duties.
• Represent the department by attending meetings, trainings, and process improvement teams.
• Maintain professional and technical knowledge by utilizing access to SCAN University on-line trainings, attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies.
• Contribute to team effort by accomplishing related results as needed.
• Actively support the achievement of SCAN’s Vision and Goals. Customer Service Representative (Temp)
Lendmark Financial Services-Long Beach, CA
April 2024 to August 2024
• Greet, assist and solicit individuals entering the office and calling by phone; receive and process credit and employment verifications, and record information obtained; process payments, distributions, make recommendations regarding loan approvals; approve loans up to established lending limits, complete loan closings, handle account activities related to collection accounts, including phone calls and face to face communications with customers.
• Prepare reports, correspondences, transaction documentation, and record and file documentation; operate cash drawer, process bank deposits, maintain records and balances and closing of the branch.
• Actively market all branch products and services to individuals. Sales Support Representative (Temp)
SCAN Health Plan-Long Beach, CA
August 2023 to December 2023
• Answer phone calls from internal sales representatives as well as external broker agents.
• Provide excellent customer service to the contracted Broker community and SCAN Sales Representatives.
• Responds to questions regarding eligibility, network, formulary, benefit design, commissions, as well as related topics or concerns.
• Provide follow-up to callers as needed to resolve the inquiry, in a timely fashion.
• Escalate appropriate issues to management, and route calls to internal departments when needed.
• Maintain professional knowledge of Medicare and SCAN benefits by successfully completing required training.
• Document all calls and action items in the Sales Support call log, according to department standards.
• Contribute to team effort by accomplishing related results as needed. Personal Loan Specialist
OneMain Financial-Long Beach, CA
March 2023 to June 2023
• Deliver results related to individual and branch sales goals as well as customer expectations.
• Develop new relationships and maintain existing relationships, working with customers throughout the loan process and loan life cycle.
• Present financial solutions, based on customer needs, that meet their goals.
• Present customers with optional insurance products.
• Educate customers on the terms and conditions of their loan to ensure a clear understanding.
• Partner with local businesses to seek out and develop new customers.
• Manage the life cycle of the loan, including collections activities, complying with all laws and regulations. Retail Assistant Manager
T-Mobile-Long Beach, CA
January 2022 to March 2023
• Delivering exceptional customer experience by assisting the Store Manager.
• Leading, coaching, and developing the team of store sales associates.
• Enthusiastic leader capable of multi-tasking, demonstrate a great eye with an attention to detail.
• Have a passionate focus on helping all of the employees and any customer that enters the store. Retail Sales Leader
T-Mobile-Long Beach, CA
September 2021 to January 2022
• Builds proficiency related to serving and selling to customers providing a best-in-class customer experience.
• Helping customers pick up right where they left off in their shopping journey with consultative selling and services.
• Exploring individual needs and providing hands-on demonstrations of the latest and greatest technology in-store.
• Guide customers through their purchasing experience with thoughtful questions, informative answers, and sharing your expertise.
• Makes the most of working time on shift by learning and seeking out new information.
• Balancing customer service experience and performance goals. Mobile Expert
T-Mobile-Long Beach, CA
September 2020 to September 2021
• Assess customer needs and educate the customers with our services and products.
• Meet and exceed individual and team sales goals.
• Promote the highest level of customer service with integrity, energy, and passion.
• Complete training to keep up to date with company standards.
• Focusing energy and effort in developing a world class sales team to ensure the customers become our clients.
• Having the energy and passion for winning.
Caregiver
Crystal Stairs-Compton, CA
August 2018 to December 2019
• Monitors and supervises children keeping them safe and healthy.
• Prepares food and snacks for children and organizes meal time.
• Helps children maintain good hygiene and changes the diapers of infants and toddlers.
• Organizes activities designed to help children learn about their world and develop their own interests.
• Watches for any signs of behavioral or emotional problems in children and alerts parents to the problems.
• Works with children on language skills and creative activities like art, music and dance. Crew Member
McDonald's-Signal Hill, CA
December 2015 to December 2016
• Welcoming customers as they arrive at the order counter.
• Provide customers with the menu and suggest food items as per their preferences.
• Inform customers of any special or new deals that the company has introduced.
• Take orders by punching them into the POS database.
• Take cash and process credit cards exchange of meals sold.
• Handle preparation of fountain drink, shakes, ice creams, hot/cold coffee.
• Doing table services and operating the fry station.
• Assemble orders and safely pack them.
Corps Member
Conservation Corps-Long Beach, CA
March 2012 to June 2014
• Help developed five mini-parks.
• Graffiti performed litter abatement.
• Steam cleaning Belmont Shore, trash pick-up, alley clean up and landscaping.
• Internship at the Environmental Services Bureau on the recycling hotline.
• Internship at City Hall recycling all thirteen floors.
• Waste Management intern helping with phone calls.
• Bus stop maintenance and steam cleaning.
• Clean up for the Willow/Cherry and Anaheim corridor.
• Park clean up and maintenance.
Education
Science (Associate Degree)
Long Beach City College-Long Beach, CA
February 2016 to August 2020
General Studies (High School Diploma)
John Muir Charter School-Long Beach, CA
February 2012 to September 2013
Skills
• Toddler Care
• Store management
• Microsoft Excel
• Customer support
• Strong organizational skills
• POS
• Phone etiquette
• English
• Care plans
• CMS
• Sales
• Office management
• NetSuite
• Clerical experience
• Organizational skills
• Time management
• Computer networking
• Microsoft Word
• Cash handling
• Administrative experience
• Microsoft Outlook
• Technical support
• Work well in high pressure environment
• Medical office experience
• HIPAA
• Windows
• Computer Skills
• Data entry
• Data Entry
• Excel
• Sales Support
• Customer relationship management
• Handle a variety of tasks at one time
• Bilingual, ability to understand Khmer
• Outbound calling
• Caregiving
• Proficient in Microsoft Office
• Citrix
• Strong work ethics
• Customer service
• Retail sales
• Basic math skills
• Order fulfillment
• Cash register
• Mobile devices
• Medicare
• Google Docs
• Office experience
• Retail Management
• Ability to operate office equipment's
• Ability to type 45+ wpm
• Filing
• Verbal and written communication
• Workday
• Front desk
• Fluent
• Communication skills
• Salesforce
• Intermediate
• Microsoft Office
• Khmer
• Customer service oriented
• Medical terminology
• Retail Sales
• Typing
• iOS
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