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Provider Services Representative Resume Example

Resume Score: 80%

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PROVIDER SERVICES REPRESENTATIVE
Summary

Patient professional talented at assisting customers with questions and concerns, entering and updating customer details and managing escalated issues. Enthusiastic and service-oriented individual with exceptional communication and multitasking abilities. Knowledgeable Call Center Representative with experience assisting in the insurance medical field. Accomplished in recording accurate information while exceeding customers' expectations in high-volume call center. Gifted in keeping sensitive and confidential information private.

Skills
  • Customer Service
  • Telecommunications
  • Sales
  • Product Sales
  • Quality assurance optimization
  • System documentation
  • Professional telephone voice
  • Interpersonal skills
  • Account updating
  • Resolving issues
  • Liquor regulations and compliance
  • Customer greeting
  • Loss prevention
  • ID verification
  • Reliable
  • Fast learner
  • Bilingual
  • Active listening
  • Organization
Experience
05/2019 - 07/2020Provider Services Representative, BC/BS HORIZON NJ HEALTH, Winter Haven, FL

i worked in provider services helping provider with claims.

  • Supported efficient handling of complex claims and followed up on open, denied or suspended claims to complete required line.
  • Processed claims daily and expertly handled as many files with impeccable quality.
  • Tracked and reported on patterns of claims and repeat offenders to help eliminate system abuse.
  • Monitored reports to identify claims issues and worked with adjusters to resolve problems.
  • Determined liability, compensability and benefits due on each claim.
  • Evaluated customer account information to assess current issues and determine potential solutions.
  • Reviewed files, records and other obtained documents to respond to customer requests.
  • Asked probing questions to determine service needs and accurately input information into electronic systems.
  • Assisted with authorization request.
  • Provided referrals for providers requesting them
  • Assisted providers with getting credentialed with the insurance and also terminating their in network status with the insurance.
  • Assisted the provider with the how to go about with appeals and also providing the determination on the appeals as well as getting more detail regarding they're determination.
12/2018 - 05/2019Call Center Agent, The Results Companies, Winter Haven,florida, Winter Haven, FL
  • I worked with BC/BS HORIZON NJ HEALTH.
  • Pursued opportunities to advance client relations skills and further enhance customer satisfaction in every interaction.
  • Boosted productivity by maintaining strong call control and quickly working through scripts to address diverse problems.
  • Educated clients on how to navigate company systems and work within established frameworks to obtain desired services.
  • Met or exceeded call speed, accuracy and volume benchmarks on consistent basis.
  • Documented customer inquiries and feedback, including service delivery suggestions in company database.
  • Reviewed files, records and other obtained documents to respond to customer requests.
  • Asked probing questions to determine service needs and accurately input information into electronic systems.
04/2016 - 11/2018Sales Associate, Walmart, Haines City,florida, Haines City, FL

Maintained organized, presentable merchandise to drive continuous sales

  • Maintained records related to sales, returns and inventory availability
  • Organized racks and shelves to maintain store visual appeal, engage customers and promote specific merchandise
  • Implemented up-selling strategies such as recommending accessories and complementary purchases to boost revenue
  • Assisting customers with finding alternative merchandise to meet needs
  • Applied security and loss prevention training toward recognizing risks and reducing store theft
  • Trained and developed new sales team associates in products, selling techniques and company procedures
  • Worked alongside retail representatives to boost sales by enhancing product presentations and advertising collateral
  • Liaised with customers and recommended specific products and specials, aligning with individual needs, requirements and specifications
  • Maintained customer satisfaction while handling electronic product returns quickly and professionally
  • Completed orders through pick up system and organized product deliveries to meet customer timetables
  • Worked with sales team to collaboratively reach targets, consistently meeting or exceeding quotas
  • Educated customers on promotions to enhance sales
  • Delivered high level of assistance by locating products and checking store system for merchandise at other sites
  • Arranged new merchandise with signage and appealing displays to encourage customer sales and move overstock items
  • Answered incoming telephone calls to provide information about products, services, store hours, policies and promotions
  • Retained product, service and company policy knowledge to serve as resource for both coworkers and customers
  • Built and maintained effective relationships with peers and upper management to drive team success toward common sales, service and operational goals
  • Coached team members on security risks and loss prevention to aid in mitigating store theft
  • Helped average of 25 customers per day by responding to inquiries and locating products
  • Negotiated and closed deals with minimal oversight
  • Sold various products by explaining unique features and educating customers on proper application
  • Assisted customers by finding needed electronics items and checking inventory for items at other locations
  • Performed floor moves, merchandising, display maintenance and housekeeping to keep sales areas well-stocked, organized and current
  • Stayed up to date on store promotions, payment policies and security practices
  • Recommended merchandise to customers based on needs and preferences
  • Observed customer behaviors to identify security threats and escalate concerns to supervisors
04/2014 - 04/2016Cashier, Walmart Haines City Florida, Haines City, Florida
  • Restocked, arranged and organized merchandise in front lanes to drive product sales
  • Helped customers complete purchases, locate items and join reward programs to promote loyalty, satisfaction and sales numbers
  • Requested official identification for alcohol purchases and verified details, consistently meeting strict legal standards of underage sales
  • Checked identification for proof-of-age and refusing alcohol sales to underage customers
Education and Training
High School DiplomaRidge Community High School, Davenport, FL
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Resumes, and other information uploaded or provided by the user, are considered User Content governed by our Terms & Conditions. As such, it is not owned by us, and it is the user who retains ownership over such content.

Resume Overview

Companies Worked For:

  • BC/BS HORIZON NJ HEALTH
  • The Results Companies, Winter Haven,florida
  • Walmart, Haines City,florida
  • Walmart Haines City Florida

School Attended

  • Ridge Community High School

Job Titles Held:

  • Provider Services Representative
  • Call Center Agent
  • Sales Associate
  • Cashier

Degrees

  • High School Diploma

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