Sky Light

Dedicated and customer-focused Customer service Representative with over 4 years of experience providing exceptional remote support. Skilled in resolving customer inquiries, improving service processes, and enhancing customer satisfaction that fortifies client satisfaction and positive feedback. Strives in fast-paced, virtual environments following established procedures and practices to exceed all customer expectations.

Driven to provide top tier quality customer service. Innovative in leveraging extensive knowledge of products and services as well as creating solutions for customers to drive loyalty, retention, and revenue.

Customer Service Representative - HealthFirst

(2023-05 - 2026-05)

• Delivered prompt and professional responses to customer inquiries through phone, email, and chat, ensuring a seamless experience.
• Efficiently resolved customer complaints, prioritizing satisfaction and fostering longterm retention.
• Managed over 60-75 calls daily while adhering to CMS regulations, demonstrating strong organizational skills.
• Assisted members with enrolling in Medicare Advantage plans during the Open Enrollment Period (OEP) and Annual Enrollment Period (AEP).
• Addressed inquiries regarding claims and benefits, achieving an impressive first contact resolution rate of 96.7%.
• Helped members understand their benefits by reviewing their Statements of Coverage (SOC) and utilizing knowledge bases for accurate information.
• Supported timely payments to ensure members remained up to date with their monthly premiums.
• Communicated with providers' billing offices on behalf of members to ensure proper claim submissions and timely processing.
• Educated customers about insurance products, including coverage options, benefits, and pricing.
• Assisted customers in comparing different insurance plans offered by their plan sponsor to help them make informed decisions.
• Complete all required training and coaching within set timeframes.
• Obtained CPT codes from providers' offices to verify service coverage and determine the need for prior authorization.
• Utilized Rumba to validate CPT codes, identify the appropriate benefit procedures, and estimate costs for various services.
• Filed grievances for members dissatisfied with provider services, system issues, or delays in appeals.
• Initiated expedited appeals for denied pre-authorizations when standard timelines could jeopardize a member's health.
• Issued compliance letters to providers in cases of balance billing attempts, ensuring adherence to Medicare allowable rates for uncovered services.
• Resolved billing discrepancies and submitted claims for rework to facilitate prompt payments while accurately applying co-share and co-insurance as per SOC/EOC.
• Documented all interactions with consumers in Salesforce, escalating cases as necessary to maintain accurate records.
• Communicate effectively with leadership and team members during shifts, ensuring proper handoff of work.
• Managed inbound and outbound calls using the Cisco Jabber phone system, providing exceptional customer service in a professional manner.
• Applied conflict resolution skills to de-escalate tense situations and nurture positive relationships with customers.
• Collaborated closely with team members to share insights and enhance overall service quality.
• Scheduled rescheduled, and confirmed appointments with healthcare providers Process referrals, authorizations.
• Assisted members in scheduling rides for non transportation benefits with through Access2Care.
• Process referrals, authorizations, prescription renewals, and other requests.
• Verified and authenticated calls in accordance with HIPAA guidelines to protect individuals' medical records and personal health information.

Technical Support - LumiTech

(2021-01 - 2023-02)

• Managed over 30 calls daily, assisting new customers with sign-ups, retrieving consumer data, providing relevant product information, and processing service cancellations.
• Served as the first point of contact for customers seeking assistance with products and technical issues, troubleshooting online ordering problems to ensure a smooth purchasing experience.
• Responded promptly to customer inquiries regarding products, services, and company information, fostering positive relationships.
• Achieved exceptional performance by resolving approximately 90% of technical support tickets, showcasing strong problem-solving skills.
• Collaborated closely with the sales team to stay updated on inventory levels, complete pending orders, and address any item-related concerns.
• Conducted both outbound and inbound calls to address customer inquiries effectively.
• Provided timely responses to emails and delivered first-hand solutions to customer issues.
• Welcomed clients with professionalism and courtesy, creating a friendly and inviting atmosphere.
• Performed troubleshooting for network connectivity issues, set up email profiles, created passwords, accessed applications via Citrix, managed inventory, and assisted users with software such as Word, Excel, PowerPoint, Outlook, Access, and Adobe Acrobat.
• Worked in tandem with the service desk to resolve end-user computing problems efficiently.
• Addressed software and hardware issues through face-to-face interactions, phone calls, emails, and online portals.
• Maintained a keen attention to detail while precisely following documented procedures.
• Demonstrated the ability to communicate effectively with customers at various levels, from technical staff to management.
• Utilized Active Directory for tasks such as account creation, updates, password resets, data corrections, and account suspensions.
• Enhanced system security and performance by initiating the installation of new antivirus software and critical operating system updates.
• Engaged daily with customers to request information and ensure the completion of necessary paperwork.
• Helped clients with resetting their passwords for member website and application.

BSc - Computer Science and Information Systems