Customer Service & Claims Support Specialist

Sardae Dixon

*************@*****.*** 803-***-****

Professional Summary

Dedicated Customer Service and Support Specialist with 10+ years of experience in healthcare, finance, and technical support call centers. Demonstrated ability to handle 130+ daily calls, resolve complex issues, and ensure accuracy, compliance, and customer satisfaction. Skilled in data entry, claim processing, billing resolution, stakeholder communication, and quality assurance support. Recognized for problem-solving, adaptability, and policy-driven decision-making. Seeking to contribute analytical, administrative, and customer service expertise to a government agency.

Core Competencies

• Customer & Stakeholder Support

• Data Entry & Database Management

• Medical & Insurance Claims Processing

• Policy & Regulatory Compliance (HIPAA, Healthcare, Financial)

• Call Center Operations & Escalation Management

• Conflict Resolution & Problem-Solving

• Technical Troubleshooting & Help Desk Support

• Process Improvement & Quality Assurance

Summit Federal Services / Customer Service (Remote) March 2023 – May 2026

• Handled 130+ inbound calls per day regarding billing, technical device issues, and account support while consistently meeting performance metrics.

• Resolved device-related issues using step-by-step troubleshooting techniques and communicated solutions in a clear, customer-friendly manner.

• Reviewed histories, billing statements, and payment discrepancies to ensure accuracy and compliance with company policies.

• Provided thorough documentation in CRM systems, ensuring accurate recordkeeping for audits and reporting.

• Supported project teams by assisting with large-scale repeatable processes, including data entry, communications, and scheduling tasks.

• Assisted with quality assurance (QA) testing, identifying errors, documenting findings, and escalating issues for process improvement.

• Delivered help desk support, escalating unresolved technical issues to higher-level support teams as needed.

• Contributed to process improvement initiatives by identifying recurring issues, documenting trends, and making recommendations to leadership.

• Maintained professionalism and patience in escalated customer situations, improving customer satisfaction ratings.

• Collaborated with internal teams to train and mentor new hires on policies, procedures, and best practices. Customer Service Representative / Referral Care Coordinator VBOA – Sumter, SC Dec 2018 – Apr 2020

• Processed medical insurance and claims adjustments, ensuring accuracy and compliance with payer requirements.

• Coordinated patient referrals by verifying insurance eligibility, obtaining authorizations, and scheduling specialty appointments.

• Communicated with providers, patients, and healthcare facilities to ensure timely referral processing and continuity of care.

• Maintained accurate referral documentation and updated patient records in electronic systems while ensuring HIPAA compliance.

• Conducted outreach to providers to verify claim details, supporting fraud prevention and error reduction efforts.

• Handled 100+ inbound and outbound calls per day related to claim status, billing inquiries, referrals, and corrections.

• Assisted customers in understanding coverage benefits, out-of-pocket costs, and explanation of benefits (EOBs).

• Entered, reviewed, and updated claim and referral details in systems with a high level of accuracy to ensure timely processing.

• Identified discrepancies and policy issues, escalating unresolved matters to supervisors for resolution.

• Worked with cross-functional teams to streamline claims correction workflows, reducing processing delays.

• Trained new team members on claims entry processes and quality assurance procedures.

• Maintained compliance with HIPAA privacy regulations when handling confidential patient information.

• Provided written correspondence to customers and providers, ensuring clarity and professionalism. Customer Service Representative

Express Scripts – Columbia, SC Dec 2016 – Jan 2018

• Responded to patient inquiries via phone, email, and chat, providing assistance with prescription refills, billing, and insurance coverage.

• Managed 100+ calls daily while meeting key performance metrics for quality and efficiency.

• Processed patient prescription orders, refills, and prior authorization requests with accuracy and attention to detail.

• Assisted in resolving billing disputes and insurance claim rejections by verifying patient eligibility and coverage.

• Conducted outbound calls to providers and pharmacies to clarify prescription details and ensure accuracy in processing.

• Documented customer interactions and resolutions in internal systems to support audit readiness and compliance.

• Maintained strict adherence to HIPAA regulations and pharmacy compliance policies. Customer Service Agent / Escalation Specialist

Sykes Enterprises – Sumter, SC Dec 2012 – Mar 2015

• Managed 150+ calls daily in a high-volume call center, supporting Bank of America customers with account inquiries, balance checks, and transactions.

• Handled escalated calls involving sensitive financial matters, ensuring policy-compliant resolutions and customer satisfaction.

• Processed monetary adjustments, fee reversals, and account corrections within authorized limits.

• Assisted customers with fraudulent account concerns, security verifications, and password resets.

• Documented case notes and customer interactions in internal systems, ensuring accurate reporting and audit compliance.

• Collaborated with banking specialists and higher-tier representatives to resolve complex financial issues.

• Consistently exceeded customer satisfaction and call quality performance targets. Education

Associate of Health Science

Central Carolina Technical College – Sumter, SC 2019 – 2020 High School Diploma

Crestwood High School

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