Tyressa Ryals
Columbia
Summary
Results-driven Enrollment Specialist known for maintaining high productivity and efficiently completing tasks. Specialized in navigating complex enrollment systems, developing effective communication strategies, and implementing process improvements to enhance workflow. Excel in problem-solving, time management, and adaptability, ensuring smooth enrollment processes and positive outcomes for all parties involved.
Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
15
15
years of professional experience
Work History
Enrollment Specialist
United Health Group, USA
Minneapolis
06.2020 - Current
- Conducted in-home and group presentations to provide detailed explanations of policy guidelines and benefits to clients and families.
- Facilitated continuing service by processing changes in beneficiaries and analyzing policy loan applications.
- Listened to and understood customers' needs, explained and discussed options and outlined best-fit services.
- Handled new enrollments by entering customers' data and reviewing information.
- Updated and maintained databases with current information.
- Contributed innovative ideas and solutions to enhance team performance and outcomes.
- Worked with cross-functional teams to achieve goals.
- Collaborated closely with team members to achieve project objectives and meet deadlines.
- Worked effectively in team environments to make the workplace more productive.
- Recognized by management for providing exceptional customer service.
- Prioritized and organized tasks to efficiently accomplish service goals.
Benefit Consultant/Claims Advocate
Blue Cross Blue Shield of South Carolina
Columbia
09.2019 - Current
- Offer comprehensive regulatory compliance support and superior client service for all aspects of Healthcare Reform and Compliance needs
- Research and resolve complex questions and issues while ensuring a consistent closed loop resolution process is leveraged between the client and health compliance guidelines
- Consistently monitor Service Level Agreements to meet/exceed client expectations
- Selected as a Peer Mentor for newly hired employees
- Selected as a Security Advocate Team member to assist with preventing security incidents within the department
- Examine and process claims and/or non-medical appeals according to business/contract regulations, internal standards and researching guidelines. Enters claims into the claim system after verification of correct coding of procedures and diagnosis codes. Ensures claims are processing according to established quality and production standards
- Ensures effective customer relations by responding accurately, timely, and courteously to written, web, telephone, or walk in inquiries. Handles situations which may require adaptation of response or extensive research. Identifies correctly processed claims and processes adjustments and reprocessing actions according to department guidelines
- Identifies complaints and inquiries of a complex level that cannot be resolved following desk procedures and guidelines and refers these to a lead or manager for resolution
- Identifies and reports potential fraud and abuse situations
- Reviewed medical records for accurate coding on claims for processing
- Apply ICD-10, HCPCS, and CPT codes to patients claims for processing
- Produced and Monitored EOBs
- Coordinated with Membership services and processed all enrollment transactions
Account Manager
Enhanced Resource Center
Waycross
11.2016 - 08.2019
- Investigate, evaluate and settle claims, applying technical knowledge and human relation skills to effect fair and prompt disposal of cases and contribute to reduced loss ratio
- Evaluated all evidence with a goal of creating positive outcomes for client’s’ claim
- Directed and coordinated various investigations conducted by field investigation team
- Synthesized data into comprehensive quarterly written reports for management
- Reviewed and analyzed suspicious and potentially fraudulent insurance claims
- Followed up on potentially fraudulent claims initiated by claims representatives
- Analyzed information gathered by investigation and report findings and recommendations
- Investigated and assessed damage to property and reviewed property damage estimates
Account Recovery Specialist
AMCOL Systems Inc.
Columbia
03.2010 - 01.2016
- Proactively managed client correspondence and recorded all tracking and communications.
- Achieved performance goals on a consistent basis
- Discussed options with delinquent clients in terms of proposed solutions or foreclosure.
- Processed payments and applied to customer balances
- Used scripted conversation prompts to convey current account information and obtain payments
- Trained new team members on scripts, company services and performance strategies and provided mentoring
- Handled 80-100 outbound and inbound calls daily with a goal of collecting owed debt
- Negotiated to collect balance in full
- Researched accounts and completed due diligence to resolve collection problems
- Counseled debtors on payment options and arranged installment agreements
- Used probing techniques to determine debtors’ reasons for delinquency
- Delivered exceptional customer service on all calls while maintaining a calm and professional demeanor in challenging situations
Education
Dual Master’s Degree - Cybersecurity, National Security
Websters University
Columbia, SC05-2027
Bachelor’s - public health
South University
Columbia, SC06.2019
Skills
- Exceptional oral and written communication skills
- Customer Service/Satisfaction
- Microsoft Office Suite
- Word
- Excel
- PowerPoint
- Internet Explorer
- Data entry
- Multi-line phone system
- HIPAA
- OSHA 10 Certified
- Medical Terminology
- ICD9-10-CM
- DRG
- CPT/HCPCS
- Anatomy/Physiology
- SC Medicaid
- SC Medicare
- Third Party Insurance
- Internet Routing & Network Functions
- Wireshark Installation & Utilization
- IP Gateway Router Configuration
- Email (SMTP/IMAP) Configuration
- Internet Security/Protection
- Identifying Security and Threat Types
- Firewall Monitoring
- Cyber Security
- Incident response
- Regulatory compliance
- Data analysis
- Risk assessment
- Cybersecurity protocols
- Client relations
- Technical writing
- Project management
- Team collaboration
- Sales reporting
- Client prospecting
- Written communication
- Market research
- Deadline management
- Underwriting principles
- Property and casualty insurance
- Strategic planning
- Policy sales
- Regulatory requirements
- Product promotion
- Record maintenance
- Interpersonal skills
- Records maintenance
- Marketing strategy development
- Client advocacy
- Professional demeanor
- Email marketing
- Client relationship building
- Account management
- Direct marketing
- Customer complaint resolution
- Customer service
- Insurance coverage verification
- Billing procedures
- Lead development
- Confidentiality handling
- Policy Knowledge
- Mathematics skills
- Quality assurance requirements
- Negotiation skills
- Organizational skills
- Client consultations
- Loss coverage determination
- Reporting and analytics
- Insurance sales
- Application verification
- Time management abilities
- Analytical thinking
- Prospecting skills
- Customer retention
- Cold calling
- Financial needs assessment
- Registered employee benefits consultant
- Manage renewals
- Multitasking
- Cross-functional teamwork
- Decision-making
- Asset protection
- Auto insurance
- Customer engagement
- Quotes and sales
- Policy renewals
- Networking skills
- Time management proficiency
Transcripts References
Available Upon Requests
Timeline
Enrollment Specialist
United Health Group, USA
06.2020 - Current
Benefit Consultant/Claims Advocate
Blue Cross Blue Shield of South Carolina
09.2019 - Current
Account Manager
Enhanced Resource Center
11.2016 - 08.2019
Account Recovery Specialist
AMCOL Systems Inc.
03.2010 - 01.2016
Dual Master’s Degree - Cybersecurity, National Security
Websters University
Bachelor’s - public health
South University