Healthcare Customer Service Representative / Claims processor at Skylea Enterprise LLC (2017-05 – 2022-10)
- Answer inbound customer/client requests or inquiries concerning AEP, LEP, RX mail orders, account activation/ MFA resets, products, billing, equipment, claims, and report problem areas making outbound calls if necessary
- Meet and/or exceed KPIs identified by the business Internal communications/requests - client, teams, and departmental
- Verify Medical Authorizations and Referrals
- Maintain electronic records and databases making updates & corrections as needed.
- Decrease service request times by 20%. using CRM tools
- Contacting or receiving communication from customers or additional claim related third parties to obtain and/or provide necessary claim information for medical or pharmacy claims
- Review front-end claims and validate information submitted by patients or providers seeking reimbursement from the insurance company
- Maintained 96%+ Customer Satisfaction (CSAT) through efficient issue resolution while adhering to strict SLA guidelines
- Created and assigned tickets for integration and mule command issues as well as bugs or defects in systems after investigating, documenting unusual behavior, taking screen images and testing to ensure 100% in QA
- Identified patterns in recurring customer challenges and proposed a solution that automated password reset requests, freeing up approximately 12 support hours weekly for more complex issues
- Reduced software product returns by 10% by effectively troubleshooting and resolving customer issue
- Maintain accurate customer records and update customer information as needed
- Maintained confidentiality of sensitive data and followed data entry procedures and standards, ensuring compliance with regulatory requirements and protecting sensitive information
- Review No Activity PIT and Rejection PIT reports for open and pended invoices for problematic areas, with escalation to Supervisors
Technical Support Representative at Alvata Co. (2022-11 – 2023-06)
- Maintained 96%+ Customer Satisfaction (CSAT) through efficient issue resolution while adhering to strict SLA guidelines
- Created and assigned tickets for integration and mule command issues as well as bugs or defects in systems after investigating, documenting unusual behavior, taking screen images and testing to ensure 100% in QA
- Identified patterns in recurring customer challenges and proposed a solution that automated password reset requests, freeing up approximately 12 support hours weekly for more complex issues
- Reduced software product returns by 10% by effectively troubleshooting and resolving customer issue
Customer Service Specialist at Express Care Solutions (2023-09 – 2026-02)
- Handled 200+ chats daily ensuring timely responses & issue resolution resulting in 100% satisfaction
- Resolved 95% of queries in first interaction
- Maintain accurate customer records and update customer information as needed
- Maintained confidentiality of sensitive data and followed data entry procedures and standards, ensuring compliance with regulatory requirements and protecting sensitive information
- Review No Activity PIT and Rejection PIT reports for open and pended invoices for problematic areas, with escalation to Supervisors
