Member Services Representative Resume Example

• Managed a high-volume workload within a deadline-driven environment.
• Resolved an average of 50 inquiries in any given week and consistently met performance benchmarks in all areas (speed, accuracy, volume).
• Became the lead go-to person for new reps and particularly challenging calls as one of the company's primary mentors/trainers of both new and established employees.
• Helped company attain the highest customer service ratings (as determined by external auditors) -- earned 100% marks in all categories including communication skills, listening skills, problem resolution and politeness.

Responsible for answering incoming calls from customers while ensuring a high level of customer service and maximizing productivity with minimal down time. Resolved customer service inquiries including: merchandise, shipping estimated times of arrivals, member material requests, provider look-up, and authorization calls and claims status.

Key Accomplishments:

• Reduced customer complaints ratio by 66% through implementation of a dedicated complaint handling cell to cater to escalated grievances.
• Organized service workflow to meet the influx of customers, by streamlining workflow issues.
• Successfully handled 16 accounts simultaneously, without a single complaint from any account holder.

Trained and monitored employee production on a daily basis to ensure all performance goals were continually met, accounts and records were being maintained in an orderly and productive manner.

Key Accomplishments: 

• Oversaw all collector and biller activities.
• Assisted with reviews and audited complex problematic accounts.
• Maintained follow up with payers in a stratified manner.
• Assisted the section manager and performed all designated duties in the absence of the section manager.
• Interfaced with a variety of outside organizations including pediatrics, ophthalmology, transplant, and obstetrics gynecology divisions.
• Maintained records in an organized manner, corrected and re-billed denied claims when necessary, and performed secondary billing

• Recognized as #1 Customer Service Rep (out of 20 reps in division) in 2011. Ranking was based on accuracy, Monthly Collection  Goals, duration of calls and availability.
• Contributed to an 8% collection increase in 2011 by improving collection tracking techniques.
• Acted as an intermediary between the patient and the insurance company, file claims in assurance of payment.
• Advised patient on insurance coverage and benefits before a procedure or treatment. 
• Gathered missing information needed from patients to file claims