Remote Medicare & Claims Customer Service Rep

Khayla Alston

Phone: 727-***-****

Email: **********@*****.***

Location: Remote

Professional Summary

Customer service professional with 6+ years of experience in healthcare, insurance, telecommunications, and claims support. Experienced in handling inbound and outbound calls, assisting customers and members with billing, benefits, eligibility, enrollment, claims, upgrades, and account concerns. Skilled in communicating with providers and facilities, documenting interactions, resolving issues, and working effectively in remote environments. Proficient in Microsoft Office, Excel, PowerPoint, goal tracking, chart creation, 834 reconciliation, and EDI file rebuilding.

Professional Experience

Member Services Representative

CVS Health / Aetna — Retiree Solutions Center

Remote August 2025–Present

• Handle inbound calls from Aetna Medicare Advantage plan members regarding billing, enrollment, eligibility, benefits, and claims.

• Provide accurate and professional assistance while addressing member questions and concerns.

• Review member information and help resolve account and plan-related issues.

• Communicate with healthcare facilities and providers as needed to support member requests.

• Make outbound follow-up calls when an inbound call is disconnected and member outreach is appropriate.

• Document member interactions, account updates, and resolutions accurately.

• Handle sensitive member information in accordance with company procedures and privacy expectations.

• Support service goals through effective communication, attention to detail, and timely issue resolution.

Medicare Customer Service Representative

Maximus

July 2023–August 2024

• Handled inbound calls from Medicare beneficiaries regarding benefits and claims.

• Explained available Medicare information and assisted customers with questions about coverage and claim-related concerns.

• Researched customer accounts and provided accurate information based on available records and procedures.

• Documented customer interactions and maintained accurate records.

• Delivered professional, empathetic service while assisting customers with healthcare-related questions.

Customer Service Representative

Alorica — Verizon Wireless Account

October 2022–April 2023

• Handled inbound calls from VerizonWirelesscustomersregardingbilling,account concerns, and service upgrades.

• Assisted customers with understanding billing information and available upgrade options.

• Researched account details and provided appropriate resolutions based on customer needs.

• Documented call information and account updates accurately.

• Maintained a professional and customer-focused approach in a high-volume call center environment.

Auto Claims Representative

Revecore

Remote January 2021–October 2022

• Handled inbound and outbound calls related to auto insurance claims.

• Assisted with filing, updating, and completing auto claims.

• Gathered and verified information needed to process claims accurately.

• Communicated with customers and other parties regarding claim status and required information.

• Documented claim activity and maintained accurate records throughout the claims process.

• Worked remotely while managing customer interactions and claims-related tasks. Education

Wharton High School

High School Diploma Class of 2012

Skills

• Customer Service

• Inbound and Outbound Calls

• Medicare Member Support

• Benefits and Claims Assistance

• Billing Support

• Enrollment and Eligibility Support

• Insurance Claims Processing

• Provider and Facility Communication

• VerizonWirelessAccountSupport

• Microsoft Office

• Microsoft Excel

• Microsoft PowerPoint

• Spreadsheet Management

• Chart Creation

• Goal Tracking

• 834 Reconciliation

• EDI File Rebuilding

• Data Entry and Accuracy

• Documentation and Recordkeeping

• Remote Customer Support

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