Experience

Family Health Network

• Hospitals and Health Care
• 1 - 100 Employee

• MEMBER SERVICE REPRESENTIVE

  • Feb 2015 - Present

  Member Service Representative Claim Specialist • Handle incoming calls which varies from problems and complaints to inquiries and questions for all aspects of business and will originate from various sources including CCAI members, doctor offices, and hospitals and outside vendors. • Make suggestions to members/providers for more efficient services available through use of more compatible doctors, hospitals, pharmacies, dentists and/or vision centers. • Enter appropriate data in various computer programs in an efficient and accurate manner. • Contact new members to confirm enrollment and complete Health Risk Assessment for the full benefits of ICP (Medicaid), Community Complete (Dual Eligible), or Community Advantage plan & assign Care Coordinator. • Assist providers with generating authorizations for Admissions, Referrals, and Services. • Handle claim issues needing additional research for resolution in timely manner. • Assist with check issues from check traces to having checks voided and reissued. • Researches claim denials and delegate’s information amongst team members on handling denials, provider’s spreadsheet. • Communicates effectively with other staff members in the resolution of problems, complaints & inquiries. Weight Watchers Coordinator • Enroll new and current members with weight watchers program. • Obtaining members height and weight to make sure their eligible for the program. • Creating a spread sheet to keep track of the coupons being sent out to the member. • Mailing out weight watcher locations and recipes for health life styles, and also sending weight watchers coupons to members that has already done there report by mailing or faxing it in for my records. • Keeping track of how many new members enrolled in the program, by adding up the members in total and subtracting the number of coupons sent out for the whole week. Show less



MAXIMUS

• Australia
• Advertising Services
• 1 - 100 Employee

• Call Center Representative

  • Feb 2014 - Nov 2014

  Call Center Representative February 2014 to November 2014 • Answering incoming calls, greeting callers & providing information and referrals as necessary. • Conducting outbound calls as assigned. • Research customer information using various system tools, on multiple computer screens, to problem solve and provide customer with accurate information. • Record customer interaction during, or immediately after, each call to include details of inquiries, complaints comments, and actions taken. • Continuously exceed Call Center goals ensuring quality customer service. • Maintain knowledge of IL Medicaid Redetermination Process and the Affordable Care Act. • Enrolling new members with health care plans of their choice, one that fits member health care needs. • Assigning members to doctors closes to their locations. Show less



Elite Pay Global

• United States
• Financial Services
• 1 - 100 Employee

• Customer Service Representative

  • Oct 2013 - Oct 2014

  • Make outbound calls to business owners informing them on how they can save at least 30% percent on their merchant processing. • Schedule appointments with major business owners, for one of the sale leads to come out and provide more information in detail so that the business owner could get a better understanding of the product and how it works. • Make outbound calls to business owners informing them on how they can save at least 30% percent on their merchant processing. • Schedule appointments with major business owners, for one of the sale leads to come out and provide more information in detail so that the business owner could get a better understanding of the product and how it works.