Paulette Edwards

To obtain a position in a professional atmosphere, more than 20 years of successful work experience as a Call Center/Customer Service/Sales representative. Meet and obtain weekly and monthly goals, for calls received and great customer service provided to all. Received monthly goals and team awards given by the management team and department achieving monthly goals a 94%-98% monthly production goal.

Premier Service Consultant (Mobility Sales Department) at AT&T Mobility Services LLC. (2023-10 – Present)

Specialized in customer acquisition, sales, service and retention in a fast-paced environment.

• Handle customer interactions (calls, chats, emails) in a fast-paced environment
• Identify upselling opportunities and closed deals to reach sales and commission targets
• Accurately resolve issues related to service, billing, payments and collections
• Explain bills and product features clearly
• Troubleshoot basic problems, including technical issues and seek assistance from higher support if or when needed
• Provide solutions to prospective and existing customers to enhance their service experience, satisfaction and to keep loyal customers happy

Member Service Advocate at Scan Health Plan (2018-05 – 2023-08)

Provided quality customer service and educated members, family, friends, providers and caregivers regarding benefits and plan options.

• Provided quality customer service, educated the members, family, friends, providers and caregivers regarding benefits and plan options in person, via email and by telephone
• Serve members by being an advocate and point of contact for questions and concerns regarding benefits, eligibility, referrals, claims and any other aspects of plan benefits and services
• Provide follow-up with members by clarifying the customers issue, determining the cause and identifying and explaining the solution
• Escalate appropriate member issues to management or other departments as required
• Consistently meet and or exceed the department standards

Quality Management Coordinator at Delta Dental Plan of California (2015-03 – 2017-01)

Responsible for the handling of assigned appeals and grievances, researching cases, resolving issues and ensuring time frames are met.

• Handle assigned appeals and grievances by inputting into appropriate databases and writing acknowledgement letters
• Obtain dental records as needed, research cases, resolve issues and mail and fax resolution letters
• Ensure time frames are met for acknowledgement and resolution letters
• Comply with all regulatory requirements and policies of Delta Dental Plan of California
• Answer telephone inquiries and maintain a professional level of telephone etiquette
• Respond to questions from members, family members, authorized representatives, providers and others regarding appeals and grievances
• Work closely with internal departments to resolve and research member and provider reconsiderations
• Assist in investigating member claims or billing discrepancies and coordinate with the Claims Department to successfully achieve corrective actions and resolution

Correspondence Processor at Molina Healthcare (2011-09 – 2014-08)

Generate, process, track and store authorization requests and correspondence related to Care Access and monitoring approval and denials.

• Generate, process, track and store authorization requests and correspondence (electronic and hard copy) related to Care Access and monitoring approval and denials
• Handle other integrated Molina Healthcare programs including Behavioral Health and Long Term Care
• Sort and file all inbound and outbound correspondence
• Assist clinical staff with outbound faxing and data entry of member demographic and provider information updates
• Process and monitor all denial and CAM letters through Molina denial database
• Respond to and complete requests for correspondence as appropriate

Customer Relations at Delta Dental Plan of California (2001-11 – 2010-11)

Provided excellent customer service to all members regarding dental insurance eligibility and benefit questions.

• Provided excellent customer service to all members regarding their dental insurance eligibility information
• Answered benefit questions and went over claim benefits with members and dental offices
• Help members find good dental practices for services
• Processed payment for new and existing members and sent dental insurance mailing materials
• Research and respond to complex calls via telephone, emails and written inquiries regarding treatment plan questions, overcharging, refunds
• Handle complaints, disputes and file grievances for members or dental practices
• Enrolled members through employers, groups or brokers
• Meet and maintain production standards, counts and inquiry response turnaround times
• Answered between 75-120 calls per day

Certificate in Dental Assisting and X-ray License – National Educational Center (1987 – 1987)

Diploma – Alain Leroy Lock High School (1986 – 1986)