People-Oriented Customer Service Specialist Resume Title

LisaBrogden *********@*****.***

Objective

An innovator, self-starter, team player and problem solver with experience in Health Insurance, Sales and Customer Service, seeking to work with a company that will uphold their mission statement for family and friends thru their trusted employees.

Work Experience

Blue Shield of California (Remote) 04/2021-08/2024

FEP Customer Service Representative

Handle on a typical day an average 30+ calls.

Resolve incoming calls concerning member’s eligibility, benefits and provider information.

Compose routine and non-routine correspondence to answer benefits/provider inquiries.

Perform routine to mid-level inventory reduction (i.e. member inquiries, may initiate claim adjustments, respond to emails, etc)

Review and analyze member claims for accuracy as well as member education on how benefits are applied.

Participate in quality and efficiency workgroups to continuously improve quality member/customer satisfaction.

Proactively analyze available programs and engage members with their wellness plan options.

Provide status of a prior authorization requests.

Assist members when and how to appeal a coverage decision.

Other duties as assigned.

Envision RX Options (El Dorado Hills, CA) 12/2018-06/2020

Customer Service Representative

Provide prompt, accurate responses to caller’s inquiries regarding prescription drug benefit plan.

Resolve pharmacy issues and processing claims from members, providers and pharmacies.

Process billing premium payments for member. Resolve billing inquiries for members. Resolve pharmacy accounting issues.

Accurately enter clinical prior authorization forms, through the customer service software. As well from clinical or client services.

Process eligibility requests for new enrollments, termination, member status changes. Utilize the MARX Government database to update the company database For MediCare and Medicaid.

Medicare trained specialist.

Provide basic trouble shooting and support for members using the Company’s PBM and mail order applications and automated prescription phone cellular phone service.

Trinity Mutual Reverse Mortgage (Roseville, CA) 04/2017-10/2018

Inside Sales/Loan Officer Assistant

Presents Reverse Mortgage Loans in accordance with all regulations and laws.

Using leads developed by the Company, makes outbound calls and qualifies client for the next steps as defined by Company. If qualified collect all financial, pertinent information from client and originates the Reverse Mortgage Loan.

Directs client over the phone, computer, text how to complete the application ensuring all paperwork, documents and signatures are needed to process the reverse Mortgage Loan in timely and accurate manner.

Transferred all financial information to Loan Processing. Maintained active communication with Loan Processing, Loan Officer concerning client needs.

Worked with Sugar CRM, Bay Docs, and Microsoft Suite to maintain customer activity.

Achieved 100% Sales Quota.

Billennium Corporation (Los Gatos, CA ) 1990-1994

Sales Executive-Territory Manager

Introduced new mathematical software package designed to replace outdate system for mid-level engineers.

Moved from inside sales to named account sales where I was selling to Fortune 100 companies such as Lockheed, Intel, Apple, National Semi Conductor.

Achieved over 100% sales quota. Qualified for Presidents Club.

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