Results-driven Claims Representative with a solid background in insurance and healthcare. Strong analytical capabilities complemented by effective multitasking skills. Recognized for outstanding communication and customer service performance.
Excelled in a fast-paced environment by consistently delivering superior customer service during extensive call management.
Resolve customer complaints in a professional manner, while maintaining a friendly and helpful attitude.
Provide tech support and troubleshooting assistance to members with inquiries accessing and using the member portal.
Advise member regarding policy and benefit information for their health plan.
Coordinates appointment schedules based on patient preferences.
Managed scheduling for ongoing and initial consultations.
Research each patient entry to ensure that only one patient record exists by matching designated criteria in EPIC database. Identified duplicate patients and complete merge request following established guidelines.
Exhibits proficiency in managing radiology imaging timetables.
Conducted outbound calls to prompt patient scheduling of preventative exams.
Reviewed and researched assigned claims by navigating multiple computer systems and platforms and accurately capture the data necessary for processing.
Consistently met established performance standards including quality and quality claims processing standards.
Provided customer service by responding to and documenting telephone and or written inquiries.
Managed a daily influx of more than 60 calls, achieving outstanding customer satisfaction.
Resolve customer complaints in a professional manner while maintaining a friendly and helpful attitude.
Advise members regarding policy and benefit information for their health plan.
Created member-focused communication on benefit policies.
Healthcare IT Support Certificate
Circle of Excellence Top KPI Performance
Circle of Excellence KPI Performance