Dedicated Customer Service Professional motivated to maintaining highly effective consumer-focused solutions results while contributing to the company's success.
Strong organizational skills
Seasoned in conflict resolution
Sharp problem solver
Active listening skills
Adaptive team player
Customer Service Support Advisory Board
Interact with the Board of Directors to maximize customer focus an increase employee engagement.
Research, calm and rapidly resolve conflict to prevent loss of first call resolution.
Customer Service Professional June 2014 to CurrentBlue Cross Blue Shield － Winston Salem, NC
Support and be committed to the mission, vision and values of the company by delivering seamless, energetic and innovative service solutions to increase stakeholder satisfaction and retain customers.
Utilizing probing and creative problem solving methods to resolve foundational customer inquiries on first contact.
Document corrective measures and provide instructions as needed to internal business areas to ensure prompt resolution and response to customer inquiries.
Identify and obtain information and records from customers, members, providers and /or employer groups to correct/update information, claims and membership records when necessary.
Recognize patterns of inconsistent and/or inaccurate claims filing practices among customers and providers, education customers and providers on acceptable BCBSNC practices and policies.
Perform phone/email outreach to BCBSCNC vendors and business partners to resolve service issues.
Identify, understand and anticipate customers' unexpressed needs and concerns in caring manner.
Work collaboratively with Sales, Healthcare and Network Management patterns to further optimize customer, employers group and provider relations by identifying opportunities to promote stakeholder programs.
Promote programs, making sound decisions to apply the most appropriate "stakeholder centric" course of action to respond to needs.
Educate and encourage customers on use of alternative delivery channels including self-service, web, etc.
Identify and communicate process, product or systems improvement opportunities to improve the overall stakeholder experience.
Interface with local, state and federal governmental entities and plan participants regarding BCBSNC products, services and policies.
Claims Adjustment Representative January 2011 to April 2014United HealthCare － Greensboro, NC
Responsible for providing expertise or general claims support to teams in reviewing, researching, investigating, negotiating, processing and adjusting claims.
Authorizes the appropriate payment or refers claims to investigators for further review.
Conducts data entry and re-work; analyzes and identifies trends and provides reports as necessary.
Claims Representative Associate July 2006 to December 2010United HealthCare － Greensboro, NC
Provide expertise or general claims support to teams in reviewing, researching, investigating, negotiating, processing and adjusting claims.
Familiarity with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications.
Analyze and identifies trends and provides reports as necessary.
Constantly meet established productivity, schedule adherence, and quality standards.
Master of Arts : Counseling, PresentLiberty University － Lynchburg, VAContinuing education in Professional Counseling
Bachelor of Arts : Arts Psychology, June 2015Liberty University － Lynchburg, VA
Associate of Arts : Arts Psychology, 2012Forsyth Technical Community College － Winston Salem, NC
Associate of Applied Science : Medical Administration, April 2006ECPI College of Technology School of Health Sciences － Greensboro, NC
AS400, basic, Citrix, Computer Applications, creative problem solving, Data Entry, Secure email, Filing, Critical Thinking, HIPAA Gateway, MAGIC, Microsoft Office, OutLook, Negotiating, Policies, Prime, Researching, Documentation, Siebel, Customer Needs, Client Relations, Active Learning, Proactive Guidance, Probing Questions, Issue Diagnosis, Facets, Multitasking, Creative Problem Solving, Task Management, Organizational Skills, Time Management