Customer Service Quality Assurance

TYISHA ABNEY

Greensboro, NC

Versatile business professional with excellent computer skills seeks opportunity

to contribute expertise in customer service and/or health-care claims adjustment.

QUALIFICATIONS & SKILLS

14 years of customer service experience 6 years of call center experience

3 years of healthcare claims experience 2 years of claims adjustment experience

Establish rapport over the phone quickly and remain positive and upbeat while resolving issues.

Identify problems quickly and accurately.

Flexible, adjust quickly and react positively to change.

Knowledge of medical and billing terminology such as CPT, HCPCS, ICD-9, HCFA-1500 and UB-92.

Highly skilled with Microsoft Office 2007 (Word, Excel, Access, PowerPoint), Internet Explorer and several other Internet browsers.

Adept at creating macros and other shortcuts to improve efficiency.

Type 60-65 wpm.

Home office includes laptop with Windows 7, Microsoft Office 2007, 17-inch monitor and full keyboard; scanner; copier; printer; shredder; cell phone; and landline with unlimited long distance.

PROFESSIONAL EXPERIENCE

4/2008-2/2010 Rapid Resolution Expert/Claims Adjuster

UnitedHealth Group, Greensboro, NC

Adjusted medical, vision and dental claims that were processed incorrectly.

Took inbound calls and de-escalated calls.

Placed outbound calls to providers to resolve billing issues.

Used knowledge of EOB’s of other insurances and Medicare to insure proper payment.

Delighted customers with rapid resolution and initial ownership of issues.

Handled repeat callers, escalated issues and highly complex customer inquiries.

Thoroughly researched all open inquiries based on established thresholds and followed up as needed to resolve issues.

Maintained 100 percent claim processing accuracy.

Maintained at least 99 percent quality assurance performance.

1/2007-4/2008 Customer Care Professional

Replied to basic customer service inquiries regarding benefits, eligibility, member materials, providers, authorization and explanations of benefits.

Participated in proactive outbound call program to ensure customer satisfaction.

Provide excellent customer service to members and providers by identifying needs and taking appropriate action steps to satisfy them.

Solved problems systematically, using sound business judgment and follow-up.

Responded to customers in polite and courteous manner, especially in stressful situations.

Communicated unpleasant or negative information tactfully.

Consistently meet established productivity, schedule adherence and quality standards.

3/2004-1/2007 Retention Specialist / Cingular Wireless, Fayetteville, NC

Provided world class customer service to Cingular wireless customers.

Retained over 250 customers in 6-month period.

Top 10 percent in saves in the call center.

Received numerous compliments from satisfied customers .

Provided manager relief, handling manager level issues as needed.

Used computer applications such as Microsoft Office XP and Internet for billing.

Updated account information, i.e., changing rate plans and features.

De-escalated customer issues and resolved complaints.

Performed technical troubleshooting; upgraded equipment; researched disputes.

1998-2003 Customer Service Representative / Wal-Mart, Roanoke Rapids, NC

Provided customers with excellent customer service at check-out and on phone.

Assisted customers with money transfers, money orders, check cashing, faxing and photocopying.

Processed returned merchandise refunds.

Assisted customers with refilling prescriptions.

EDUCATION

Career Step

Inpatient and Outpatient Medical Coding and Billing, May 2012-present

References available upon request

Contact this candidate