Makiya Lesley
Anderson,SC
Summary
A Senior Customer Service Professional with over 6 years of experience, specializing in claims, communication, and client relations. Adept at delivering quality service to diverse customers and managing high volume queues efficiently to ensure satisfaction. Recognized for exceptional communication and interpersonal skills while interfacing with diverse clientele. Adept at identifying opportunities to enhance customer, client & business satisfaction. Committed to organization and time management.
Overview
7
7
years of professional experience
Work History
Medical Service Representative (Temp)
LifeMD -AppleOne
12.2023 - 01.2024
- Ensuring patients have the best experience possible as they enter this Virtual Patient Care platform.
- Organize Care Team incoming documents and EHR communications, reconcile inboxes items and support incoming and outgoing communication needs for the Virtual Clinic
- Answer patient questions and concerns either over the phone or via email/text. Handled customer inquiries regarding medical services, billing, and insurance coverage over the phone
- Accurately documented customer interaction in the organization's database Served as a liaison between customers and medical staff to ensure customer satisfaction
- Ensure all Protected Health Information is kept in a secure location at all times.
- Followed up on customer concerns and complaints in a timely manner Account research by contacting and responding to request from billing vendor and payers for verification of patient claim status and/or demographic information.
- Schedule patient appointments and verify insurance coverage Reviews and obtains any client information and paperwork to ensure accuracy for authorizations, billing or treatment and files documents accordingly
- Co-manage EHR schedules and calendar appointments with Care Teams
- Collect patient information and enter it into the computer system
- Process claims in a timely manner database
Medicare Enrollment Specialist (Seasonal)
Concentrix
10.2023 - 12.2023
- Review/research/resolve member issues received via service form, e‐mail or phone call
- Assisted customers with enrollment and navigating the Medicare system
- Researched Medicare eligibility and benefit information for customers Processed and verified applications for Medicare enrollment in an efficient and timely manner
- Provide a timely response to the member or appropriate department (i.e. Customer Relations, Group, Retiree Sales, Appeals & Grievances)
- Process the members PCP & IPA changes from customer relationship via email or action Update the members address/county changes
- Collects and forwards updates to billing vendor as needed to include removal of patients from collections, submission of insurance claims, and payments to be posted.
- Process the termination of deceased members
- Process requests from clinical services to update member records screen Process action grams from customer relations to update members demographic changes
- Act as decision maker for routine or non‐critical issues; provide input for issue resolution
- Responsible for enrollments and plan changes; including unenrolling, cancellations, denials, etc. In addition to Data Entry; reviewing submission for accuracy and identifying any areas of opportunity or trends requiring action specific to Quality Control.
- Maintain Quality Control reports and documentation
- Maintained and updated Medicare enrollment database Collaborated with other departments to resolve enrollment issues multi-state, multi-location Medicare experience.
- Resolve claim errors, demographic issues, duplicates, and no coverage errors in work queues.
- Followed up on incomplete applications to ensure maximum completion rate
- Assisted customers with enrollment and navigating the Medicare system
- Knowledge of billing procedures, health plans and claims processing. Utilize coding resources along with any other applicable reference material available to ensure accuracy in coding for all assigned services.
- Understanding of medical terminology to include knowledge of ICD-9, ICD-10 and CPT
Contact Center Representative
TD Bank
09.2022 - 06.2023
- Displays positive, professional tone, exhibit empathy when required and provides a Legendary Customer Experience
- Takes ownership of Customer concerns and resolve Customer issues at first point of contact
- Ensures necessary due diligence is taken to support the accuracy of all Customer transactions
- Arrives on-time and log-in ready to receive/make Customer calls as scheduled throughout the shift
- Identifies and refers high value or potential Customers to the appropriate personnel
- Provides courteous, efficient, and professional Customer service to ensure inquiries, problems and issues are resolved promptly and effectively under all conditions
- Engages Customers / partners in service conversation to understand and meet their current and future products and service needs by providing them with information / guidance
- Offers sound product knowledge as it relates to their respective business area
- Ensures Customer/partner problems are handled appropriately the first time, escalating issues when necessary
- Completes a broad range of financial transactions (e.g., withdrawals, bill payments, and/or other transactions, as necessary) in an accurate and efficient manner
- May facilitate cross-sell opportunities and/or refer Customers/partners to internal Bank partners
- Supports Customer needs and determine solutions to Customer problems, particularly as it relates to digital banking products and services
- Supports the achievement of business objectives by supporting service goals
- Understands and applies operating policies and procedures
- Contributes to business objectives for Operational Excellence
- Supports the timely and accurate completion of business processes and procedures
- Escalates non-standard or high-risk transactions / activities as necessary
- Supports and participates in process improvement opportunities
- Ensures necessary due diligence to support the accuracy of all Customer transactions / activities
- Be knowledgeable of and comply with Bank Code of Conduct
- Participates fully as a member of the team, promote team effectiveness and contribute to a positive work environment
- Supports the team by continuously developing knowledge in own area
- Participates in personal performance management and development activities, including cross training within own team
- Keeps others informed and up-to-date about all relevant or useful information related to day-to-day activities
- Contributes to a fair, positive and equitable environment that supports a diverse workforce
- Acts as a brand champion for your business area/function and the bank, both internally and/or externally.
Payroll Specialist
Intuit
12.2021 - 06.2022
- Respond to chats, emails, and calls from customers as a Subject Matter Expert
- Quickly help customers with quality solutions
- Solve problems in a creative way
- Maintain the ability to collect, research, organize and analyze data
- Document details of calls & customer interactions in the appropriate systems
- Help small & medium-sized business customers troubleshoot functionality of their Quickbooks Desktop Payroll and Payroll Taxes
- Be knowledgeable of and comply with Bank Code of Conduct and Security
- Escalates low or high-risk transactions / activities as necessary
- Completes financial transactions (bill payments, payroll subscriptions and/or other transactions, as necessary) in an accurate and efficient manner Risk Management & Risk Assessment Fraud Flagging (Recognizing Fraudulent Activity and Behaviors in accounts and customers during interactions).
Digital Support Specialist
TTI Corporate
01.2021 - 11.2021
- Ability to communicate well using Chat and Email to assist customers with claims
- Ability to professionally handle irate callers and high-stress situations
- Excellent phone skills & able to enter data efficiently
- Ability to satisfy consumers and end-users with minimal request for management intervention
- Review, investigate, and resolve issues quickly
- Proficient with Microsoft Word and Excel
- Respond accurately to consumer, service center & distributor calls regarding the company's policies and procedures
- Verify and authorize warranty coverage for all callers
- Provide helpful directions to callers dealing with warranty & non-warranty service
- Resolve issues for ASC or consumers while maintaining a flexible approach to enforcing policy
- Provide callers with a location to purchase parts & receive repair service
- Work with internal customers on warranty claims, stock issues, lost or damaged freight
- Enter orders, provide pricing and stock availability and status of order to all customers
- Must be able to convey knowledge of products and troubleshoot and interpret instructions from a manual and basic product diagram
- Must be a team player.
Executive Customer Relations / Claims Management
Alorica
10.2018 - 08.2019
- Carefully examine documentation and explore for further details when needed
- Analytical and curious, intent on asking questions and finding answers
- Comfortable presenting findings to appropriate parties even when delivering difficult decisions to clients and or management
- Review and reject/approve Exchanges and/or Refunds requested by Customer Care departments
- Responsible for ensuring that Customer Care complies with Samsung's warranty policy and procedures including Bill of Sale (receipt) & other requirements prior to approval
- Responsible for following up with the customer to obtain necessary documents and/or provide updated information to progress the case for shipment or payment
- Manage multiple tasks to accomplish set KPI targets (inbound customer communication, new cases, follow up on pending cases, etc.)
- Communicate with the vendor to resolve issue(s) regarding payment method, payment link, acceptance document, pick up request
- Must maintain a general understanding of policies and procedures
- Possess strong interpersonal skills using tact, patience, and courtesy
- Maintain the ability to collect, research, organize and analyze data
- Excellent communication, interpersonal and negotiation skills via SMS, Chat & Email
- SAP Experience
- Outbound calling to customers regarding exchanges and refunds on products
- Specialized in De-escalating
- Previously worked in technical support! Troubleshooting Samsung Devices.
Direct Care Staff
New Foundations Home for Children
02.2017 - 10.2018
- Create and facilitate an atmosphere that is most conducive to the growth, success, and safety of the clients
- Create and facilitate a positive, respectful interaction with clients
- Initiate, engage, and participate in a full range of activities with clients include but not limited to recreational, educational, social, and group activities
- If needed provide physical restraints based on TCI (Therapeutic Crisis Intervention) training requirements and demonstrate competency in all aspects of TCI training
- Supervises and document client's weekly behavior and provides therapeutic intervention as needed
- Provides supervision of clients that must be in eyesight at all times while engaged in on/off-campus New Foundation Activities.
Administrative Assistant/Receptionist
New Foundations Home for Children
02.2017 - 10.2018
- Enhanced office efficiency by streamlining administrative processes and implementing organizational systems.
- Supported executive staff through scheduling meetings, coordinating travel arrangements, and preparing crucial documents.
- Boosted team productivity by managing communication channels and ensuring timely responses to inquiries.
- Ensured accurate record-keeping with diligent data entry and database management for vital company information.
- Delivered excellent customer service through prompt responses to client inquiries, addressing concerns effectively, and building strong relationships.
- Maintained confidentiality of sensitive information by adhering to strict privacy policies and implementing secure filing systems.
- Improved document organization with thorough file maintenance, archiving outdated records as necessary for efficient retrieval when needed.
- Optimized calendar management for executives by scheduling appointments strategically while considering priorities and minimizing conflicts.
- Promoted a positive work environment through effective communication skills and fostering professional relationships among colleagues.
- Coordinated office supply inventory management, proactively ordering necessary items before depletion to avoid workflow disruptions.
- Answered multi-line phone system, routing calls, delivering messages to staff and greeting visitors.
Education
High school diploma -
Crescent High School
Iva, SC06.2011
Skills
- Customer Service
- Troubleshooting
- Information Technology
- Administrative Experience
- Bookkeeping
- Data Entry
- Payroll Specialist
- Desktop Support
- Technical Support
- Help Desk
- Computer Networking
- Sales Experience
- Outbound Sales
Timeline
Medical Service Representative (Temp)
LifeMD -AppleOne
12.2023 - 01.2024
Medicare Enrollment Specialist (Seasonal)
Concentrix
10.2023 - 12.2023
Contact Center Representative
TD Bank
09.2022 - 06.2023
Payroll Specialist
Intuit
12.2021 - 06.2022
Digital Support Specialist
TTI Corporate
01.2021 - 11.2021
Executive Customer Relations / Claims Management
Alorica
10.2018 - 08.2019
Direct Care Staff
New Foundations Home for Children
02.2017 - 10.2018
Administrative Assistant/Receptionist
New Foundations Home for Children
02.2017 - 10.2018
High school diploma -
Crescent High School
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