Customer Service Representative

Daijaih Haynes **** Misty Water Dr, Decatu,

GA, *0032 404-***-****)

adx4da@r.postjobfree.com

EXPERIENCE

Walmart, — General Merchandise Associate

December 2020 - August 2021

Help customers find what they need.

Organizing shelves

Stocking shelves

putting returns items back to the original location. Zoning different departments. (Making shelves of items look neat and presentable.

Arise — Customer Service Representative September 2021- January 2022

As a customer service representative working remote, you will interact directly with customers and support them

throughout the process

You’ll also resolve issues or complaints in a remote environment Share information about products, services, and support options Provide order support services

Promote customer success services

Ensure every customer has a pleasant experience overall Gastro Health,— Insurance Collection Specialist (Remote) February 2022- January2023

Provides Liaison between the providers of health care services, the patient, or other responsible persons, and revenue sources, to ensure the correctness of charges, a current record of all transactions, and account resolution

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Maintains active communications with insurance carriers and third-party carriers until account is paid

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SKILLS

Warehouse Experience, Time

management, Customer

service, Microsoft word,

Organizational Skills,

Communication skills,

Computer literacy,Teamwork,

Inventory Control, Picking,

Packing, Sorting

Negotiates payment of current and past due accounts by direct telephone and written correspondence

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Updates patient account information

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Monitors and identifies payer denial trends and problem accounts; communicates patterns to supervisor

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Runs a monthly aging report based on DOS and current A/R to identify accounts that require follow up

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Manage all assigned worklist on a daily basis for assigned insurances

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Utilize collection techniques to resolve accounts according to company's policies and procedures

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Report any coding related denial to the Coding Specialist

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Performs other duties including but limited to faxing information as required, generating retroactive authorization requests, and verifying medical eligibility

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Conducts necessary research to ensure proper reimbursement of claims

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Assist with special projects assigned by Billing Manager or Supervisor CVS, — Customer Service Representative

February 2023- Present

calls, plan sponsors, PSS/ISO, members and providers. Provides customized interaction based on customer preference and individualized needs, creating an emotional connection with our members by understanding and engaging the member to the fullest. Fully understands the member’s needs by building a trusting and caring relationship with the member.

Anticipates customer needs. Provides the customer with related information to answer the unasked questions, e.g. additional plan details, benefit plan details, member self-service tools, etc. Uses customer service threshold framework to make financial decisions to resolve member issues.

Educates and assists customers on various elements of benefit plan information and available services created to enhance the overall customer service experience with the company (i.e., assistance with member self-service tools, Consultation Opportunities – Simple Steps, Cost of Care Tools, Natural Alternatives Program, etc.).

Utilizes all relevant information to effectively influence member engagement.

Takes immediate action when confronted with a problem or made aware of a situation.

Takes ownership of each customer contact to resolve their issues and connect them with additional services as appropriate. Identifies member needs beyond the initial inquiry by answering the unasked questions.

Resolves issues without or with limited management intervention. Provides education to members to support them in managing their health. Responds quickly to meet customer needs and resolve problems while avoiding over-committing.

Other activities may include: providing claim status information, benefit coverage interpretations, and explaining plan eligibility. Processes claim referrals, new claim hand-offs, and escalates issues as appropriate through the system for grievances and appeals. Initiates out-reach/welcome calls to ensure constituents expectations are met or exceeded. Identifies trends and any emerging customer service issues and works to develop solutions to address potential problems and/or plan features of interest as an approach to improve understanding of benefit plans and increase post-enrollment member satisfaction. Partners with other departments to deliver client specific presentations. Coordinates efforts both internally and across departments to successfully resolve service issues and develop process improvement intended to enhance the overall delivery of service.

Works collaboratively with colleagues to deliver the best customer experience,.

Seeks to understand the customer, including circumstances, problems, expectations and needs.

Asks probing questions to identify the underlying customer needs. Appropriately transitions conversations to explore possibilities for extending customer interactions.

Guides members to the appropriate health resource. Offers alternatives where appropriate .

Acts with the best interest of customer in mind and central to all interactions.

Collaborates with colleagues and co-workers to deliver a world class customer experience.

Serves as SME providing technical assistance when needed on call related issues, products, and/or system applications delivery matters. May participate in preparation and presentation of client specific presentations.

May track and trend data. Coaches, trains and assists in the development of call center staff, as required.

Participates in and/or leads special projects/initiatives addressing service issues, as necessary.

Provides technical or subject matter expertise concerning policies, procedures, and function-related applications/systems tools as needed. Delivers internal quality reviews.

Provides appropriate support in third party audits when required. Documents and tracks all contacts, events, and outcomes with clients using appropriate systems and processes

North Druid Hills High School, Location — Degree

August 2018- May 2021

High School Diploma.

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