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Outreach/ Member Services Representative Resume

SUMMARY:

  • Professional with 4  year's customer service/call center experience in various industries
  • Worked with collection system to provide daily communication with delinquent debtors
  • Strong negotiations skills
  • Multiple administrative duties including but not limited to collecting and processed payments, insurance verifications, and worked aging reports and researched discrepancies
  • Created appeals, followed up with insurance providers, and resubmitted invoices
  • Time management skills
  • Exceptional communication skills both verbal and written
  • Proficient with MS Word, Excel, PowerPoint, Outlook, Patient scheduling, Claims processing, Bookkeeping concepts/Financial, Administration and Health Insurance Processing, CMS

PROFESSIONAL EXPERIENCE:

Confidential

Outreach/ Member services Representative

Responsibilities:
  • Perform verbal and written outreach to members who are identified as requiring targeted vision care services.
  • Provides telephone follow - up calls to ensure members have completed their preventive care services as indicated by the health management program in which they participate.
  • Serve as the initial point of contact for member complaints/grievances
  • Responsible for accurately tracking daily outreach activities
  • Reach performance and productivity goals as established
  • Maintain confidentiality and security of information
  • Document and direct complex member issues to the appropriate management level

Confidential

Customer Service Representative/Legal Assistant

Responsibilities:
  • Maintained case organization by establishing and organizing files; monitoring calendars; meeting deadlines; documenting actions; inputting information into file database and case management software; confirming case status with attorney.
  • Helps develop cases by maintaining contact with people involved in the case; scheduling depositions; preparing and forwarding summonses and subpoenas; drafting complaints; preparing and filing discovery requests; preparing responses to opposing counsel; generating status reports.
  • Maintained communication with clients by maintaining contact; communicating case progress.
  • Maintains case costs by verifying outstanding balances with attorney, clients, and providers.
  • Supported case preparation by preparing case summaries and materials for mediation conferences; preparing pleadings; monitoring and obtaining discovery responses; organizing materials for team case review.
  • Enhances trial proceedings by organizing evidence; preparing exhibits; scheduling witnesses; ensuring that witnesses are ready when needed; taking courtroom notes.
  • Updates job knowledge by participating in educational opportunities; reading professional publications.

Confidential

Collections Specialist 

Responsibilities:
  • The duties of a Collections Specialist include collection calls and/or correspondence in a fast paced goal oriented collections department.
  • Providing customer service regarding collection issues, process customer refunds, process and review account adjustments, resolve client discrepancies and short payments. Responsible for monitoring and maintaining assigned accounts- Customer calls, account adjustments, small balance write off, customer reconciliations and processing credit memos.
  • Accountable for reducing delinquency for assigned accounts.

Confidential 

Collections Specialist  

Responsibilities:
  • Handled 100  inbound/outbound calls on average in a call center environment
  • Followed up on delinquent accounts
  • Finalized communication with delinquent debtors when accounts are past due and charge off
  • Negotiated and set up payment plans and arrangements
  • Collected and processed payments

Confidential 

Medical Billing / Collector/ Claims

Responsibilities:
  • Review patient bills for accuracy and completeness and obtain any missing information
  • Knowledge of insurance guidelines especially Medicare and state Medicaid
  • Follow up on unpaid claims within standard billing cycle timeframe
  • Check each insurance payment is for accuracy and compliance with contract discount
  • Call insurance companies regarding any discrepancy in payments if necessary
  • Identify and bill secondary or tertiary insurances
  • All accounts are to be reviewed for insurance or patient follow-up
  • Answer all patient or insurance telephone inquiries pertaining to assigned accounts

Confidential

Collections Specialist

Responsibilities:
  • Contacted customers to collect outstanding payments
  • Handled incoming calls and assisted customers with inquiries about payments
  • Informed customers of active foreclosure process and passed on to a processor
  • Loan modification explanation 
  • Handled 50-100 inbound/outbound calls daily
  • Negotiated and set up payment plans and arrangements
  • Collected and processed payments

Confidential  

Pharmacy Technician/ Call Center Representive

Responsibilities:
  • Provided excellent customer service while multi- tasking in a high volume call center environment to answer physician, pharmacy and client queries
  • Checked and verified prescription authorizations and overrides using an internal database
  • Handled or redirected client complaints and concerns as needed
  • Followed CMS guidelines and regulations closely
  • Client follow-up in a timely manner
  • Assisted management with additional task as needed
  • Maintained a high rate of client retention through quality service

Confidential                      

Pharmacy Tech

Responsibilities:
  • Followed HIPPA privacy standards
  • Verified patient demographic against prescription to ensure correct patient receives medication
  • Assisted with the pulling, labeling and filling of prescriptions provide quality, empathic customer service throughout the entire drop off/ pick up process

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