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Customer Care Specialist/Seasonal Resume Example

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JD
CUSTOMER CARE SPECIALIST/SEASONAL
Summary

Detail-oriented individual well-known for being disciplined. Sharp and well-trained in Management,Customer Service, Administration,IT support talent. Pursuing a career with a company that has a great culture that has outstanding moral within the team and can grow. I am confident with my experience and skill set my exceptional skills will be appreciated.

Skills
  • Staff support
  • Inventory oversight
  • Trained in SQL
  • Oral and written communication
  • Schedule management
  • Financial administration
  • Recruiting and Hiring
  • Cost analysis and savings
  • Compensation/benefits administration
  • Profit and loss accountability
  • Goal setting
  • Policy/program development
  • Proficient in SQL,Cloud,QNXT,Facets,Data analysis, claim processing, Rxclaims, excel,outlook,word,pivot tables, visio,ICD-10, CPT Codes
  • Strategic decision making
  • Reporting and documentation
  • Data entry
  • Ability to prioritize
  • Motivational leadership style
  • Scheduling and calendar management
  • Accounts payable and receivable
  • Digital marketing
  • Rapport and relationship building
  • Quick learner
  • Experience Engineering
  • Providing customer support
  • Customer complaint resolution
  • Customer relations experience
  • Serving customer needs
  • Handling customer complaints
  • Customer follow up
  • Managing office supplies
  • Meeting planning
  • Recordkeeping and bookkeeping
  • Employee training and development
  • Faxing documents
  • Microsoft
  • PC proficient
  • Documentation and reporting
  • Customer management
  • Knowledge of HMOs, Medicare and Medi-Cal
  • Administrative support
  • Inventory management
  • Team Management
  • Team Building
  • Supervision
Experience
Customer Care Specialist/Seasonal / BroadPath Healthcare Solutions - Remote, TN11/2018 - 02/2019
  • Kept customer and system account information accurate and current to support timely resolutions for all concerns.
  • Prepared, completed and processed customer account forms and database changes.
  • Delivered fast, friendly and knowledgeable service for routine questions and service complaints.
  • Exceeded company productivity standards by 98% on consistent basis, handling more than 200 calls of quota each day.
  • Followed up on emailed or web-submitted customer inquiries within the same day.
  • Documented conversations with customers to track requests, problems and solutions.
  • Researched resolutions, contacted necessary departments and responded back to customer back phone, mail or fax as follow up.
  • Resolved billing and service issues for Medicare customers.
  • Enforced compliance with organizational policies and federal requirements regarding confidentiality.
  • Managed benefit contract pricing, processing, policies and procedures.
  • Researched and communicated insurance requirements, including patient financial responsibilities and fee-for-service
  • Accurately input procedure codes, diagnosis codes and patient information into billing software to generate up-to-date invoices.
  • Reviewed all claims for accurateness and appropriateness.
  • Reviewed account information to confirm patient and insurance information is accurate and complete.
  • Checked claims coding for accuracy with ICD-10 standards.
  • Entered procedure codes, diagnosis codes and patient information into billing software to facilitate invoicing and account management.
  • Reconciled codes against services rendered.
  • Addressed and responded to staff and client inquiries regarding CPT and diagnosis codes.
  • Documented and filed patient data and medical records.
  • Added modifiers, coded narrative diagnosis and verified diagnoses.
  • Reconciled clinical notes, patient forms and health information for compliance with HIPAA rules.
Claims Representative/Claims Processor / Sykes Enterprises Inc./TMG Health - Remote, TN08/2015 - 11/2018
  • Delivered quality customer service to assigned, insured and claimants throughout entire claims lifecycle to promote effective service times for all parties.
  • Reviewed documentation and accounts to gain full picture.
  • Verified details with policyholders and requested additional information.
  • Stayed current on HIPAA regulations, benefits claims processing, medical terminology, and other procedures.
  • Inputted data into the system, ensuring that provider coding information and reported services were correct.
  • Reviewed administrative guidelines whenever questions arose during the processing of claims.
  • Ensured claims were billed and paid correctly.
  • Handled the modification and updating of policies.
  • Precisely calculated refunds, premiums, and adjustments.
  • Verified policy holder data, including age, contact number and physical address.
  • Complied with confidentiality regulations in handling customer information.
  • Produced high-quality images for referring physicians.
  • Kept operations running smoothly and solved diverse problems by coordinating with customers, management and internal departments.
  • Worked with nurses and other clinical staff to process patients and direct to appropriate departments.
  • Provided caring companionship to elderly and developmentally disabled patients.
Customer Service Representative / Sykes Enterprises Inc./Bluecross Blueshield - Remote, TN02/2012 - 07/2015
  • Delivered high level of service and support to each customer, paving way for future business opportunities.
  • Informed customers about billing procedures, processed payments and provided payment option setup assistance.
  • Maintained calm, friendly demeanor with upset customers to de-escalate stressful situations.
  • Collected customer feedback and recommended procedural or product changes to enhance future service delivery.
  • Assisted approximately 200 customers each day with Medicare/plan questions.
  • Evaluated benefits for each caller to determine service needs and address concerns.
  • Documented conversations with customers to track requests, problems and solutions.
  • Handled billing related activities focused on medical specialties.
  • Followed specific security rules and guidelines to protect sensitive data, including patient medical records and payment card information.
  • Verified that patients had the proper insurance coverage prior to any procedures or appointment scheduling.
  • Ensured that all patient and insurance data was updated regularly and carefully inputted into the company's computer system.
  • Instructed clients on amounts covered under benefits plans in easy-to-understand terminolog.
  • Examined claims, records and procedures to grant approval of coverage.
  • Signed payment approvals accepted claims.
  • Retained strong medical terminology understanding in effort to better comprehend procedures.
  • Ensured that appropriate coding is managed to maximize efficiency.
  • Icd-10 knowledge,DRG/ CPT knowledge/certified through trizetto
  • HIPPA certified
  • Answered patient questions regarding medication.
  • Responded to telephone inquiries and provided information about order status, store hours and pharmacy procedures.
IT Technical Support /Account Management / Microsoft - Remote, TN04/2007 - 02/2012
  • Disassembled computer systems to troubleshoot and resolve hardware issues.
  • Installed software updates and vulnerability patches on xbox servers to prevent possible threats from penetrating networks.
  • Maintained composure and patience in face of difficult customer situations, applying deescalation techniques and positive customer support.
  • Consistently responded to customer service emails within standard window for optimal response.
  • Reviewed current hardware and software and recommended modifications to increase system speed.
  • Researched, documented and escalated support cases to higher levels of support when unable to resolve issues using available resources.
  • Partnered with project management teams on development of scope and timelines.
Education and Training
Campbell County Comprehensive High School - Jacksboro, TN06/2003High School Diploma
Saint Gregory's University - Murfreesboro, TN12/2019Bachelor of Arts
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Resume Overview

Companies Worked For:

  • BroadPath Healthcare Solutions
  • Sykes Enterprises Inc./TMG Health
  • Sykes Enterprises Inc./Bluecross Blueshield
  • Microsoft

School Attended

  • Campbell County Comprehensive High School
  • Saint Gregory's University

Job Titles Held:

  • Customer Care Specialist/Seasonal
  • Claims Representative/Claims Processor
  • Customer Service Representative
  • IT Technical Support /Account Management

Degrees

  • Campbell County Comprehensive High School - Jacksboro, TN 06/2003 High School Diploma
    Saint Gregory's University - Murfreesboro, TN 12/2019 Bachelor of Arts

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