Customer Solutions & Claims Specialist Professional

WENDY MORGAN

Customer Service & Program Management Professional

Myrtle Beach, SC

Phone: 843-***-****

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

LinkedIn: linkedin.com/in/wendy-morgan-1b555b3b

PROFESSIONAL SUMMARY

Customer Success professional with 25+ years of experience delivering high-quality service and improving customer satisfaction across healthcare, municipal waste reduction, and corporate environments. Proven strengths in team leadership, program management, onboarding, accounts receivable, process improvement and operational support. Known for adaptability, strong problem-solving skills, and a customer-focused approach that supports organizational goals in fast-paced settings. CORE SKILLS

Customer Service & Advocacy

Accounts Receivable & Collections

Process Improvement

Team Training & Mentoring

Data Analysis & Reporting

Professional Communication Skills

Negotiation Skills

Google Docs, CRM, SaaS

Microsoft Word, Excel, Outlook,

Teams, Access, Power Point, One Note

& Publisher

Salesforce Dynamics 365 Zoom

Canva Wix Zoom

Medical Claims Processing & Deferral

Resolution

DoD C2 Clearance

Medical Referral Management

ICD-10, CPT, HCPCS Coding

HIPAA Compliance

PROFESSIONAL EXPERIENCE

Medical Claims Processor I (TRICARE East)

Ask Consulting (Contract) – PGBA / BCBS of South Carolina On-Site October 2025 – Present

• Process medical claims accurately and efficiently in accordance with business regulations and internal guidelines.

• Verify procedure and diagnosis codes to ensure compliance and payment accuracy.

• Resolve system edits, audits, and claims errors using approved investigative resources.

• Coordinate with internal departments to update patient, provider, and insurance records.

• Mentor newly trained team members on systems, workflows, and quality standards. Medical Referral Management Specialist (TRICARE West) Maximus Remote

March 2025 – October 2025

• Met or exceeded departmental productivity and performance metrics.

• Processed referrals and authorizations for behavioral health, specialty care, DME, inpatient admissions, urgent care, and military treatment facilities.

• Ensured strict adherence to HIPAA and TriWest confidentiality guidelines.

• Assisted beneficiaries, family members, and military personnel with provider referrals.

• Applied working knowledge of ICD-10, CPT, and HCPCS coding systems. Customer Service Advocate II (TRICARE West)

PGBA / BCBS Surfside Beach, SC (On-Site to Remote) September 2024 – March 2025

• Completed an intensive three-month training program and earned multiple certifications.

• Responded to approximately 50 daily calls from beneficiaries and providers regarding claims and appeals.

• Delivered high-quality customer service to military personnel and healthcare providers.

• Utilized medical coding knowledge to research and resolve claim issues. Manager, Customer Service & Special Programs / AR Specialist WasteZero, Inc. Murrells Inlet, SC

June 2008 – April 2024

• Managed customer service operations supporting over 100 municipal waste-reduction programs resulting in 65% reduction in solid waste.

• Led onboarding, retail program implementation, third party revenue management, product distribution and inventory, ongoing customer success initiatives.

• Developed and implemented SOPs, training programs, and process improvements to streamline workflows.

• Resolved escalated customer disputes and strengthened client relationships.

• Achieved departmental financial goals, increasing collections to 95%. Medical Billing Clerk

Tri Hospital EMS Port Huron, MI

February 2008 – June 2008

• Processed insurance claims using medical terminology and payer guidelines.

• Managed billing, collections, and follow-up with insurance carriers.

• Provided customer support to patients and healthcare providers. Design Studio Administrator & Show Coordinator

General Motors Design Center Warren, MI

January 2005 – September 2006

• Supported studio operations, branding consistency, and project coordination.

• Managed multiple concurrent projects while meeting strict deadlines.

• Improved workflows through organization and time-saving techniques. Director of Special Events

Detroit Institute of Ophthalmology Grosse Pointe Park, MI April 2001 – August 2004

• Directed multiple fundraising events, budgets, sponsorships, and vendor relationships.

• Designed marketing materials, presentations, and event publications.

• Improved operational efficiency through scheduling, budgeting, and process planning. EDUCATION

Medical Office Administration

Saint Clair Community College – Port Huron, MI

Early Childhood Education

Charles Stewart Mott Community College – Flint, MI Dean’s List: 1993, 1998

ADDITIONAL INFORMATION

• Volunteer Chairperson, Murrells Inlet Leisure Friends (Sea-Beyond Foundation)

• Employment timeline gaps and additional history available upon request

• References available upon request

Contact this candidate