Medicare Assist Line Resume Example

Correspondence phone support responds to and resolves various customer inquiries via telephone and correspondence and resolves claims problems within established production and quality standards. Answers incoming calls and written requests for information from members or providers promptly and accurately.

• Resolves incoming calls concerning member's eligibility, benefits, provider information, monthly premium billing, clinical and pharmacy needs.
  
• Composes routine and non-routine correspondence to answer benefits/provider inquiries in writing.
  
• Performs inventory reduction, routine to mid-level (i.e., member inquiries, may initiate claim adjustments, responds to emails, etc.)
  
• Reviews and analyzes member claims for accuracy as well as member education on how benefits are applied.
  
• Participate in quality and efficiency workgroups to continuously improve quality member/customer satisfaction as requested.
  
• Enhanced knowledge of medical terminology.
  
• Assist members may when and how to appeal a coverage decision.
  
• Other duties as assigned.

Upholding our mission of providing service worthy of our family and friends. Priority is for our members to experience the utmost care and compassion by conveying empathy, resolving all issues, and helping them get back to enjoying their lives as quickly and effortlessly as possible. Empowered to provide members with peace of mind that their current problem is resolved and that none are on the horizon.

• Excel at figuring out logic puzzles, welcome challenges, and have a passion for helping others in what could be their most vulnerable moment.
  
• Proactively analyze available programs, determine program eligibility and connect the member to appropriate BSC vendors, Health Advocates, Social Workers, Pharmacy Techs, and Pharmacists.
• Provide prescription-related benefit coverage (e.g., explanation of coverage or benefits summary related): Provide prescription co-pays. Provide prescription formulary coverage information and utilization management requirements using web-posted printed formulary. Provide a brief description of coverage denial reasons and alternatives as listed in the printed formulary. Perform prescription claim overrides.
• Provide status of prior authorization requests.
• Coordinates membership changes such as member's primary care physician.

Apple Inc. is an American multinational technology company headquartered in Cupertino, California, that designs, develops, and sells consumer electronics, computer software, and online services.

• Responsible for the tactical, daily execution of the business to include negotiating programs and demand generation, operational optimization, and building deep relationships to achieve a great customer experience with results that benefit Apple and our partners.
• Pre-screened applicants, gathered the information for credit applications, contracts, and credit approvals, as well as securing and maintaining customer contracts.
• Responsible for managing and growing territory, maximizing short term revenue, building future sales pipeline through demonstrated account and territory planning.
• Coordinate the involvement of company personnel, including support, service, and management resources, in order to meet account performance objectives and customers' expectations.
• Provided executive leadership and oversight for full sales and customer relationship development for numerous new accounts and existing accounts.
• Gather and analyze valuable consumer market, competitive intelligence, and share info with the account team on a regular basis.
• Developed efficiency-enhancing workflow/process improvements that made it possible to accommodate increasing responsibilities necessitated by staff reductions.
• Tracked customer activity, market to customers and connect with potential customers via Salesforce.

Apple Inc. is an American multinational technology company headquartered in Cupertino, California, that designs, develops, and sells consumer

electronics, computer software, and online services.

• Maintain a high-volume workload within a fast-paced environment. Assisted an average of 550 clients in any given week and consistently met performance benchmarks in all areas (speed, accuracy, and volume).
• Earned 100% marks in all categories including communication skills, listening skills, problem resolution, and politeness. (e.g. CSAT: Customer Satisfaction Score, SERVQUAL, Customer Retention Rate)
• Proficiently and professionally responded to customer and sales representatives questions about orders, product availability, backorders, price, products and services, procedures and policy.
• Assisted customers in navigating the companies website, placing orders online and troubleshooting any technical issues.
• Initiated investigation of order entry errors, damaged product, and return discrepancies. Worked cross-functionally to ensure corrections were processed accurately and timely.
• Promptly and methodically responded to customer inquiries to identify and resolve issues with initiative and good judgment.
• Performed a variety of concurrent tasks, handled escalations, time-critical issues, maintained time-sensitive records and created reports.
• Skilled in the use of automated customer response systems (e.g. GCRM: Global Client Relationship Management, SAP: Systems Applications and Products, GMAC: Global Management Application Contract)