Customer Service Specialist with Insurance Focus

Alice Hughes

Jackson, MS ***** 601-***-**** ********@*****.***

Experience

Morgan White Group

Customer Service Specialist, Ridgeland, MS

March 2020 - Present

Successfully resolve customer issues by meticulously following established policies and procedures.

Proficiently manage the reinstatement and termination of dental and vision plans based on customer status.

Conduct daily review of voicemails and promptly returned calls, ensuring timely responses to inquiries and updates for customers.

Effectively communicate with customers to review and confirm coverage limits for vision and dental benefits.

Process claims applied them to deductible, coinsurance, or co-pay, and generated and sent explanation of benefits for declined claims.

Utilize the Service Request feature to ensure accurate and efficient completion of customer requests, either internally or through proper departmental transfer.

Manage the processing of monthly and annual benefit payments, ensuring accuracy and compliance with established procedures.

Alorica

Customer Service Representative, Call Center, Jackson, MS

November 2018- March 2020

Facilitated the smooth transfer, initiation, and termination of electricity services for clients spanning Texas, Louisiana, Mississippi, and Arkansas.

Authenticated patient accounts with an attention to detail, providing comprehensive explanations of billing statements to ensure customer understanding.

Proactively processed outages and emergencies and swiftly responding to critical situations to minimize downtime and ensure customer satisfaction.

Maintained and updated customer data, ensuring accuracy and completeness to enhance service efficiency.

Skillfully resolved and de-escalated customer issues related to outages, maintaining a calm and professional demeanor in high-pressure situations.

Conduent

Customer Care Representative, Madison, MS

November 2014 – November 2018

Verified eligibility for Medicare and other insurances, ensuring accurate and compliant documentation.

Effectively communicated detailed explanations of benefits to members, fostering understanding and satisfaction.

Applied payments to patient accounts with precision, maintaining an organized and up-to-date financial record.

Quoted benefits and coinsurance amounts to clients expressing interest, providing comprehensive and accurate information.

Authenticated patient accounts and submitted medical claims for processing, adhering to established procedures and regulations.

Conducted thorough reviews of insurance plans to identify the best options for clients, ensuring optimal coverage.

Initiated authorization for medications by contacting providers and pharmacies, demonstrating proactive and effective communication skills.

Burger King

Shift Manager, Jackson, MS

March 2008 – May 2014

Oversaw a team of 10 part-time and full-time employees

Developed and maintained schedules to accommodate fluctuating workloads

Education

Accounting, Hinds Community College Raymond, MS 2002-2003

Communication, Tougaloo College Jackson, MS -2001-2002

Diploma, Lanier High School Jackson, MS

Certifications

Humana MSO Verification of Benefits, Authorization, Billing, Enrollment, Pharmacy Benefits, Specialty Claims, Dental and Medical Claims

Customer-focused and detail-oriented professional with a proven track record in efficiently resolving customer issues and managing dental, medical, and vision benefits. Skilled in adhering to policies and procedures, processing claims, and ensuring seamless communication with clients. Efficient in utilizing specialized tools to facilitate internal processes and proficient in providing comprehensive explanations of benefits.

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