Customer Service Rep/Office Assistant

BRENDA E. BENT

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Lithonia, GA 30038 * *******@*****.***

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CUSTOMER SERVICE REPRESENTATIVE

with an impressive 16 track record in client relations management providing swift resolution to customer complaints ultimately repairing trust and winning loyalty.

EXPERIENCE

Compliance Specialist Group Dental Service, Rockville, MD 2009 - 2011

Responded to inbound service calls in a fast-paced, high-volume call center while performing other duties.

Provided superior customer service and work quality while demonstrating attention to detail, flexibility and innovation in resolving problems.

Researched and resolved issues from plan participants, union locals, providers, the DOI and the CMS regarding dental eligibility, benefits, claim status, appeals & grievance requests regulatory state reporting and state form filings.

Responded to and documented all inquiries, set-up claims to be re-opened; processed check tracers, stop payments and claims audits.

Maintained superior performance evaluations by focusing on customer commitment and satisfaction.

Communicated with customers and new subscribers regarding general service inquiries and promotion of products and services.

Researched and resolved appeal inquiries within 15-days.

Ensured all formal reviews were completed within 45-days in accordance with policies.

Sr. Service Representative United Healthcare, Elkridge, MD 2007 - 2009

Resolved problems by clarifying the customer's complaint; determining the cause of the problem; selecting and explaining the best solution to solve the problem; expediting correction; and following up to ensure resolution.

Promptly and effectively responded to escalated Medicaid customer service issues with the assistance of the case management nursing staff as reported by the Maryland DHMH.

Researched and resolved health benefits, claims and administrative questions and/or issues.

Maintained a 100% rating by meeting and exceeding customer service quotas.

Consistently commended for initiative, enthusiasm, tenacity, persuasiveness, intense customer focus and dependability in performance evaluations.

Benefit Coordinator R. J. Wilson & Associates, Forest Hills, MD 2005 - 2007

Coordinated employee benefit eligibility transactions and administered health benefit programs for employer groups consisting of 15+staff.

Analyzed and researched the details of medical and dental benefit plans and contracts that included PPO, POS, HMO and Self-Insured plans.

Negotiated and resolved claim and policy discrepancies between insurance carrier and health providers.

Advised clients and their staff at Open Enrollments presentations and Recruitment Fairs in collaboration with the marketing team.

Enrollment Team Lead Neighborhood Health Plan, Boston, MA 1997 - 2005

Team Lead for a of 10+ enrollment staff, directly monitoring and coaching daily service performance.

Researched and resolved escalated customer complaints and issues, ensuring one call resolution.

Expedited all necessary updates for eligibility maintenance; including plan changes, dependent additions or deletions, cancellations or termination of plans, regional changes and provider/hospital changes.

EDUCATION

9/2010-12/2011, Montgomery College, Public Health, Rockville, MD

9/1999-1/2002, Northeastern University, Business, Boston, MA

9/1993-12/1995, Bridgewater State College, Sociology, Bridgewater, MA

Proficient in various multiline phone systems such as Siemens, ShoreTel, RCS, ViSYS and Cisco. Proficient in using Microsoft Office Suite (Word, Excel, PowerPoint, Access, and Outlook), WordPerfect,

Adobe, Wonderbox, Oracle, and PeopleSoft

Keyboarding Speed (50 wpm)

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