Customer Service

NAEJA WASHINGTON

Holly Springs, North Carolina 201-***-**** *********@*****.***

Summary

Highly skilled and experienced professional with expertise in customer service roles. Proven ability to effectively communicate with customers, patients, physicians. and colleagues. I am proficient in finances, insurance claims, benefits eligibility, and white glove customer service. Strong attention to detail, accuracy, and problem-solving skills. Demonstrated commitment to providing exceptional customer service and support in a fast-paced environment. Skills

Excellent Customer Service

Microsoft Office Proficiency

Multitasking Skills

Analytical Skills

Empathy

Data Entry & 10 Key Proficiency

Insurance Reimbursement

Adherence

Medical Terminology

Active Listening Skills

Time Management & Organization

Complex Problem-Solving Skills

Type 60 WPM

Benefits Verification

Experience

Claims Representative 05/2023 to 12/2025

Teleperformance (Remote)

Identified patients’ needs, clarified information, researched all issues, and provided solutions and alternatives.

Answered incoming calls, verified patient information, patient check in/out, coordinated, and facilitated patient appointments.

Maintained strict confidentiality of patient information in systems as established by the appropriate protocols and policies.

Prepared prior authorization requests received by validating prescriber and member information.

Facilitated prompt payment of approved claims by liaising with finance department to ensure smooth transaction processing.

Served as a subject matter expert on specialized claims, providing guidance and support to team members when needed.

Researched denied claims, conducted reviews of medical records, and supported documentation against denied claims.

Corresponded to patient and physician’s questions regarding EOB’s, patient balances, co-pays, deductibles, write-offs, etc.

Provided data-driven recommendations to optimize reimbursement strategies and reduce claim denials. Customer Service Representative 07d/2020 to 04/2023 Ciox Health (Remote)

Suggested generic alternatives for medications to patients to help save on prescription copayments.

Completed medical and/or pharmacy benefit investigations.

Reviewed for prior authorization, step edit identification and appeals according to program standard operating procedures.

Maintained knowledge of the different types of payers including private, commercial, and government insurances.

Adhered to HIPAA policies and protocols, becoming HIPAA certified.

Provided information to patients about referrals to other doctor’s offices, specialists, and surgeons.

Resolved patient complaints and explained why certain services aren’t covered.

Researched denied claims, conducted coding reviews of medical records, and supported documentation against denied claims.

Explained copays, deductibles, coinsurance, and out of pocket maximum to members.

Determined coverage availability and coordinated the final aspects of services to ensure patients have access to prescribed therapy. Customer Care Representative 04/2018 to 05/2020

Cox Communications (Raleigh, NC)

Mentored new hires, fostering a supportive team environment that encouraged personal growth and professional development

Ensured compliance with all relevant regulations by regularly updating the team on policy changes.

Troubleshoot customer equipment to ensure products are working

Scheduled technicians to assist customers with technical needs that cannot be fixed over the phone.

Promoted a positive work culture by recognizing outstanding team performance on a regular basis.

Managed escalated customer issues with diplomacy, ensuring satisfactory resolutions for both parties involved

Coordinated cross-training programs 10 increase workforce flexibility and preparedness during times of unexpectedly high call volume.

Enhanced customer satisfaction by addressing and resolving concerns, and complaints in a timely manner.

Helped large number of customers every day with positive attitude and focus on customer satisfaction.

Assisted call-in customers with questions and orders.

Logged call information and solutions provided into the internal database.

Educated customers about billing, payment processing and support Education

Shaw University – Bachelor of Science

Fayetteville Technical Community College – Associates in Applied Science

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