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CSR Resume Example

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CSR
Professional Summary

Experienced Customer service  professional with strong leadership and relationship-building skills.

Skilled member service rep with experience in the Medical insurance  industry. Familiar with QNIX, CRM,power-point, Excel  and mult-systems .

Skills
agency, benefits, billing, critical thinking, customer service, email, government, imaging, Insurance, access, office, policies, primary care, Problem solving, product and service information, tax, telephone, phone
Skills
  • Strong verbal communication
  • Self-motivated
  • Extremely organized

Strong verbal communication

Self-motivated

Extremely organized

Strong computer skills

Strong problem solving skills
Work History
October 2015-April 2017 MSR1 Molina Healthcare | Houston, TX
  • Provides new and existing members with the best possible service in relation to billing inquiries, service requests, suggestions and complaints.
  • Resolves member inquiries and complaints fairly and effectively.
  • Provides product and service information to members, and identifies opportunities to maintain and increase member relationships.
  • Recommends and implements programs to support member needs.
  • Verify HIPPA and insurance information, explain EOBs with the member.
  • Providing exemplary customer service to customer including members, providers, government agencies and the general public.
  • Addressing complex member inquiries, questions and concerns in all areas including enrollment, claims, benefits referrals and authorizations for medical care.
  • Assists with formal training needs of new employees as needed.
  • Address HEIS concerns with member to remind them of upcoming yearly exams.
  • The capacity to retain and utilize information, facts, policies, procedures, resources and codes to ensure accurate.
  • Finding primary care or specialist in geographical area or specialty.
August 2015-October 2015 CSR | Cigna Health spring | Houston, TX
  • As a customer service rep respond to inquiries regarding benefits, billing, eligibility, coverage and other related information and provide solutions for members, agent brokers and health care professional via phone and or email.
  • Problem solving, critical thinking and empathy skills were essential to each and every caller.
  • The ability to converse with customer by phone in to provide information about products and services, to educate about Cigna health spring, processing coverage determination, grievance, organization determination, and prescription drugs over rides, appeals, in a timely manner.
  • Update and note all members account.
  • Complacent with HIPPA guidelines, interacted with customers and business partners both internal and external.
  • Ability to service customers across all call platforms as required by business needs.
  • Determination out of pocket costs related to medical, dental office visits, prescription medications, inpatient and outpatient procedures, diagnostic imaging for treatment of injuries, medical equipment and preventive care.
  • The capacity to retain and utilize information, facts, policies, procedures, resources and codes to ensure accurate.
  • Finding primary care or specialist in geographical area or specialty.
January 2015-March 2015 Billing Customer Service Rep Gexa NextEra |
  • Greet customers in a courteous, friendly and professional manner.
  • Listen attentively to customer needs and concerns displaying empathy.
  • Understand the customer requirements; probe for and confirm issues or problem.
  • Meet customer requirements through first contact resolution.
  • Prepare complete and accurate work and update customer file.
  • Effectively transfer misdirected customer requests to an appropriate party.
  • Solve problems that ate sometimes unstructured and that may require conceptual thinking.
  • Answer all billing questions and concerns of Gexa.
October 2013-April 2014 Enrollment Specialists Health and Civilian Back Solutions |
  • Reasonable for enrollment with the Affordable Care Act and access to federal, State and local programs that provide financially support for medical and other related services.
  • Determine patient eligibility for and facilitate enrollment in affordable health insurance coverage through the marketplace, Medicaid or the Children's Health Insurance program.
  • High level of incoming calls Professionally answer telephone calls, respond to routine questions and redirect calls when appropriate to customer concerns.
  • Help individuals with understanding web-based decision tools to help narrow the choices for qualified health plans.
  • Provide information about tax credits and cost sharing subsidies.
  • Refer customer with appeals, grievances and complaints to the appropriate agency.
  • Enter accurate data into computer systems.
  • Explain qualified health plans, essential health benefits and rights when using insurance Assist members with selecting the best benefit plan options enrollment process.
Education
AAS: Business Houston Community College, Houston, TX Business
High School Diploma: Wheatly High School
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Resume Overview

Companies Worked For:

  • MSR1 Molina Healthcare
  • Cigna Health spring
  • Gexa NextEra
  • Enrollment Specialists Health and Civilian Back Solutions

School Attended

  • Houston Community College
  • Wheatly High School

Job Titles Held:

  • CSR
  • Billing Customer Service Rep

Degrees

  • AAS : Business
    High School Diploma :

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