Detail-oriented Claim Specialist/ Customer Service Rep with expertise in reviewing, classifying, coding and rating applications. Successful in maintaining highest standards of quality control. Technologically-savvy with proven customer service, time management and multitasking abilities. Attentive to customer needs and able to break down technical problems to develop effective solutions
Customer-oriented team player with expertise in customer relationship management, conflict resolution and up-selling.
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Working from a home office taking incoming calls from Customers wanting sales and services from a wide range of products and service that our company offered. Resolving their questions or concerns by actively listening to identify their issues to be able to build customer relationships, earning their loyalty and trust. Maintain and updates customer information as necessary. Troubleshooting problems and resolving a range of customer issues from plan changes and account changes, to billing, to service concerns while making calmly attempts to resolve and de-escalate any issues escalates calls. Processing of credit card authorizations. Address customer questions and concerns regarding product and delivery information Provide product information, review alternative solutions if an item is out of stock and place orders for the customer. Providing extraordinary service on inbound calls in a fast-paced, structured customer care environment by following our Customer First philosophy
Consult with card members to understand their needs and tailor unique solutions for each customer, reinforcing the benefits of card membership, providing relevant product offers that deepen customer engagement and result in measurable value for our card members
Continuously improve on key selling skills, including building rapport, understanding customer needs, handling objections and closing sales
Address general and account-specific customer inquiries; provide clear and concise information and updating customer account information, as needed
Use tools and resources to identify custom solutions and anticipate customer needs, in our commitment to maintain a first point of contact resolution
Meet and exceed performance goals that include, but are not limited to, customer survey results, sales rates, quality goals, compliance regulations and productivity targets. Also help our technical support department in assisting customer by having a technical aptitude with a confident familiarity of Smartphones, tablets, operating systems, PC and Macs. Successfully negotiate and appease customers using a variety of method Tracks call-related information for auditing and reporting purposes. Provides feedback reports on all issues related to downtime and/or training issues. Providing Technical Support and Troubleshooting Customer Device and making recommended changes to their software of there products and services. Transferring calls to the appropriate departments when necessary. Answers inquiries by email or live chat clarifying desired
information; researching, locating, and providing information on orders made by the customers. Resolving any problems by clarifying issues; researching and exploring answers and alternative solutions; implementing solutions; and handling any all escalating unresolved problems. Fulfills requests by clarifying desired information; completing transactions; forwarding requests. Sells additional services by recognizing opportunities to EDUCATION AND TRAINING up-sell accounts; explaining new features. Maintains call center database by entering information. Keeps equipment operational by following established procedures; reporting malfunctions to IT Department. Updates job knowledge by participating in on the job training opportunities as well as furthering ongoing education outside of the work environment. Being able to stay customer focus to provide the best customer service by showing excellent problem solving, multi-tasking interpersonal, people skills also making use of the data entry skills on a window base system.
Taking incoming calls from subscribers who have a self-insured contract with Blue Cross & Blue Shield. Explaining Medicare part A and B. Paying and sorting HCFA claims, as well as reviewing and correction ICD-9 & CPT on claims forms by having the provider resubmit the claim with the corrected codes. Processes claims that pend for various hold reasons(COBHD, CLATH, MLATH COBPR, CLATH, DUPLM, CRCLM, NOSPT, AUHEL, AUHEL and EDI CODES), to assist in the final determination on claim disposition.
Processes adjustments related to projects or provider disputes providing timely follow-up provider call backs . Responding to written correspondence in a timely manner. Explaining co-payments, mental health, routine physical, out of pocket expense, DME. Accurately adjudicate claims in accordance with health plan guidelines, company standards, and company procedures. Maintain minimum production standards as set by our client Maintain a 99% or above financial accuracy rate, 97% pay accuracy rate and a 96% or above procedural accuracy rate. Review claims for appropriate information and accurate reimbursement. Prioritize and manage individual workflow as needed by its Julian Date Maintain completed and updated set of resource materials necessary for processing claims as well as attending all company-mandated training and remain current with knowledge in the claims field and processing data entry of claims as needed. Processing claims according to multiple plan guidelines also applying the application of the deductible, coinsurance, and copayments. Ability to research and adjudicate CMS-1500 and UB-04 claims of all levels on Xcelys system. Running Ad Hoc Reports when needed.
Taking incoming calls from customer with MCI Long Distance or new customer seeking MCI as there long distance carrier. Offering customer discounts, promotions, free web hosting for the customer with Internet Service who may have wanted to cancel their service with MCI. Going over customers billing accounts to ensure that they were getting the best saving. Taking payment for the customer who was paying their account with a check or credit cards and or helping them make a payment arrangement.
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