Customer Service & Claims Specialist Enthusiast
Resume:
Carol Grant
Email: **************@*****.***
Professional Profile
Dedicated customer service professional with 10+ years’ experience in a fast-paced environment seeking an opportunity in a team-orientated company. Obtain a customer service position with the opportunity to focus on leadership, communication and customer relation skills. Proficient in Microsoft office (Word, Excel, Outlook, PowerPoint) 2003, 2007 and 2010.
Areas of Expertise & Qualifications
Train and Evaluate Customer Service
Team Work Problem Solver
Adaptability Communication
Follow Up Skills Patience & Flexibility
Types 60wpm Organized and detail-oriented
SUMMARY
Actively seeking a customer service position where I can optimize my problem-solving and organizational skills to contribute to increased customer satisfaction.
Strong multitasking skills and fast learning ability ensure quick contribution to your customer service team.
Able to effectively communicate with customers using a multitude of channels to provide world class service with every interaction.
EMPLOYMENT HISTORY/EXPERIENCE:
03/2016-12/2019, TMF/C2C Innovative, Claims Clerk Medicare Part A East, Jacksonville, FL
Review and research assigned claims by navigating multiple computer systems and platforms and accurately capturing the data / information necessary for processing. ensure that the proper benefits are applied to each claim by using the appropriate processes and procedures (e.g. claims processing policies and procedures, grievance procedures, state mandates, CMS / Medicare guidelines, benefit plan documents / certificates).
Complete on a daily basis all data entry required to document and communicate the status of claims as needed adhering to all reporting requirements.
Communicate and collaborate with members and providers to resolve claims errors / issues, using clear, simple language to ensure understanding.
Learn and leverages new systems and training resources to help apply claims processes / procedures appropriately (e.g. on-line training classes, coaches / mentors).
Meet the performance goals established for the position in the areas of: efficiency, accuracy, quality, member satisfaction and attendance.
Meets or exceeds all department standards: productivity; quality; and attendance.
Responsible for resolving a high volume of claims edits for all lines of business
04/2013 – 01/2016, Cook. Boston’s,
Supervises kitchen personnel under the direction of the Manager.
Prepares food to order according to recipe, procedures, standard of quality, consistency and time lines.
Examines portioning and garnishing of completed food orders.
Notifies serving personnel when orders are ready
Maintains sanitation procedures and organization of work area adhering to all OSHA regulations.
06/21/2010 - 11/28/2013, Order Picker. Grainger,
Successfully filed customer orders and delivering them to the delivery platform. Met company standards for safety, security, and productivity.
Instrumental in reducing picking error expenses and customer service issues.
Assembled various types of merchandise for shipment.
Efficiently picked customer orders for shipment; ensured correct numbers and types of products were loaded and shipped to worldwide locations.
Conveyed items and materials from receiving and production areas to storage or other designated areas by hand. Accurately sorted and placed materials and items on racks, shelves or in bins according to predetermined sequence, i.e. size, type, style, or product code.
Recorded amount of materials/items received and distributed.
Ensured inbound and outbound shipments were accurate and free of damage.
03/01/2005-05/01/2008, Host & Assistant Manager. HMS/Chili’s,
Oversaw and managed daily operations of all areas of the restaurant. Made final decisions on the matters of importance concerning guest services. Advertised specials and daily activities.
Adhered to company standards and service levels and increased sales and minimized costs; i.e. Food, beverage, supply and labor costs.
Enforced sanitary practices for food handling, general cleanliness, and maintenance of kitchen and dining areas.
Ensured compliance with operational standards, company policies, federal/state/local laws, and ordinances.
Maintained professional restaurant image, proper uniforms and appearance standards.
Investigated and resolved complaints concerning food quality and service to ensure that guest were satisfied with their dining experience.
06/01/2000-02/01/2005, Customer Service/Data Entry. Randstad,
As Customer Service Representative interacted with company’s customers to provide information to address inquiries regarding products and services.
Dealt with and helped resolve customer complaints, such as assisting in opening accounts to helping to resolve problems for customers who had problems accessing their accounts, etc. Handled Problems of customer inquiries which involved some form of complaint that had to be analyzed and handled in accordance with company’s guidelines and policies and determining the best use of resources.
Instrumental in solving problems or at least proposed solutions; when authorized sent customers replacement products or reversed erroneous fees. Other times functioned like a gatekeeper, gathered information on the problem and passed it along to the supervisor to solve.
Ensured that complaints made were valid and did whatever within the bounds of my authority to ensure the customer was satisfied when the phone call ended. Performed Office admin work which involved answering telephone calls and making appropriate transfers, data entry, to processing new client accounts, maintaining customer accounts, implementing changes to existing accounts, copying and filing records/documents, preparing reports, closing out financial tasks of accounts maintenance and servicing accounts. Mailed bills, contracts, policies, invoices, and or checks.
EDUCATION
Jean Ribault High School ~ HS Diploma, 1997
Onsite (OJT) Training in Food Services Regulatory Requirement ~ 2004 and 2005
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