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Member Service Advocate Resume Example

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JC
Jessica Claire
, , 100 Montgomery St. 10th Floor (555) 432-1000, resumesample@example.com
Professional Summary

Knowledgeable and dedicated customer service professional with extensive experience in medicare industry. Solid team player with outgoing, positive demeanor and proven skills in establishing rapport with clients. Motivated to maintain customer satisfaction and contribute to company success. Specialize in quality, speed and process optimization. Articulate, energetic and results-oriented with exemplary passion for developing relationships, cultivating partnerships and growing businesses.

Adept at prioritizing tasks, maintaining organization and optimizing workflow. Experience managing company reputation with customers. Highly efficient and professional problem-solving and communication skills.

Skills
  • Creative Problem Solving
  • Data Entry and Maintenance
  • Efficient and Detail-Oriented
  • Calm and Professional Under Pressure
  • De-escalation Techniques
  • Multitasking and Prioritization
  • Issue and Complaint Resolution
  • Verbal and Written Communication
  • Team-Oriented and Cooperative
  • Excellent Attention to Detail
  • Patient and Empathetic
  • Computer/Microsoft Office Proficiency
  • Strong Analytical and Problem Solving Skills
  • Quality Assurance
Work History
03/2020 to Current Member Service Advocate Api Group Corporation | Billings, MT,
  • Maintained updated knowledge of internal processes and industry best practices to optimize service delivery.
  • Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
  • Promoted superior experience by addressing customer concerns, demonstrating empathy and resolving problems swiftly.
  • Met all customer call guidelines including service levels, handle time and productivity.
  • Investigated and resolved customer inquiries and complaints quickly.
  • Document member inquiries and resolutions provided per Centers for Medicare and Medicaid compliance criteria.
  • Align to CMS mandates in handling organization/coverage determinations, and grievances and appeals.
  • High-quality service with a strong emphasis on member advocacy and patient safety.
  • Place outbound calls to physicians, DME vendors, pharmacies or other entities to coordinate benefits and care for the member.
  • Mastery of multiple disciplines such as but not limited to: pharmacy; plan medical, dental & vision benefits, case management, compliance requirements and more.
  • Active listening and proactively providing solutions, ensuring the members utmost health and safety.
  • Continuous referencing of policies and protocols.
05/2018 to 02/2020 MEDICAL DOCUMENTATION CLERK MedEnvios Healthcare | City, STATE,
  • Provided primary customer support to internal and external customers in fast-paced environment.
  • Answered customer telephone calls promptly to avoid on-hold wait times.
  • Suggested new procedure to persuade cancelling customers to stay with company, resulting in 50% decrease in cancellations.
  • Offered advice and assistance to customers, paying attention to special needs or wants.
  • Boosted sales revenue by skillfully receiving completed prescriptions with required medical documentation attached.
  • Provided clerical support to company employees by copying, faxing, filing documents, and mailing orders to patients/doctors.
  • Promptly answered multi-line phone system and greeted callers enthusiastically.
  • Maintained courteous, friendly atmosphere for guests to increase overall satisfaction and customer service standards.
  • Consulted with multiple doctor offices to resolve discrepancies and create effective solutions.
  • Provided excellent customer service by efficiently resolving issues and responding to inquiries.
  • Operated in dynamic, high-volume call center to provide skilled assistance to more than 60 customers each day.
  • Verify patients medical plan and coverage.(Including Part B Medicare, HMO/PPOs).
  • Answer and respond to physicians office staff inquiries through inbound and outbound calls.
  • Ensures follow-up with physicians offices to obtain prescription.
  • Processed medical records requests from outside providers according to facility, state and federal law.
  • Maintained patient records in compliance with security regulations.
  • Reviewed medical records for completeness and filed records in alphabetic and numeric order.
  • Kept accurate log of all requests for medical information and records.
08/2014 to 04/2018 Receptionist Nail Fever 3 | City, STATE,
  • Conducted over 500 calls per week, resulting in a high rate of returns.
  • Greet customers and answer busy multi-line phone system; screened calls, and referred callers to appropriate personal as necessary in a timely fashion.
  • Provide high quality customer service and expertise on a variety of products and services.
  • Organize the store to ensure excellent customer experience and secure recurring customers.
  • Perform cashier duties, product and customer assistance, as well as complete duties as required.
  • Served as the only bilingual customer service representative in the company.
  • Facilitate in upselling products to clients to further increase company profits.
  • Special abilities to foresee client needs and attend to them in a unique and timely manner.
  • Manage internal relationships to create positive and efficient work environment.
  • Sincerely enjoy working with people, in person and over the phone.
  • Greeted incoming visitors and customers professionally and provided friendly, knowledgeable assistance.
  • Scheduled and confirmed appointments beforehand to ensure following workday accuracy.
  • Oversaw inventory activities, including materials monitoring, ordering or requisition and supply stocking or re-stocking.
  • Kept reception area clean and neat to give visitors positive first impression.
  • Resolved customer problems and complaints.
Education
Expected in 01/2021 Associate of Arts | Pre-Medicine, Chemistry and Biology Miami Dade College, Miami, FL GPA:
  • Job-related courses: Human Anatomy , Medical Terminology and Nutrition.
  • Microsoft Platforms: Word, Excel, Powerpoint, and Outlook.
Languages
Spanish:
Native or Bilingual
Negotiated:
English:
Negotiated:

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Resume Overview

School Attended
  • Miami Dade College
Job Titles Held:
  • Member Service Advocate
  • MEDICAL DOCUMENTATION CLERK
  • Receptionist
Degrees
  • Associate of Arts