Customer Service
Representative
* Provided high quality
customer service by managing 30-40 inbound calls daily from healthcare
providers, verifying insurance coverage and member eligibility, confirming
authorization requirements for procedures, providing status updates, and
delivering accurate Information,
maintaining a 90% first call resolution rate.
* Utilized company - specific
internal tools to perform precise data entry and update members records,
ensuring data integrity and seamless workflow.
* Coordinated with multiple
teams to resolve documentation gaps, verify insurance details and expedite
authorization approvals.
* Resolved provider inquiries
promptly by researching and addressing issues accurately, improving case
resolution turnaround times and reducing follow up calls, which
contributed to high provider satisfaction scores.
Back Office Representative
* Processed and reviewed high
volumes of prior authorization requests for medical procedures in
compliance with insurance guidelines, ensuring accurate documentation and
timely approvals that minimized delays in patient care.
* Reviewed documents for
accuracy and completeness; conducted research on codes and terminology to
support proper processing.
* Performed precise data entry
and maintained accurate patient records while strictly upholding
confidentiality, ensuring full compliance with HIPAA regulations and
internal policies to protect sensitive health information.
* Contributed to the team's
success by consistently meeting or exceeding performance targets, helping
the team achieve and often surpass quota goals. Recognized with a reward
for perfect attendance.
