VALERI HORTON

• Handled inbound calls from members and providers, assisting with requests regarding eligibility, benefits, and demographic updates while ensuring accurate and timely responses to inquiries.
• Resolved customer inquiries efficiently using CRM systems, ensuring high satisfaction levels.
• Served high volume of customers daily with positive attitude, prioritizing customer satisfaction and effective issue resolution.
• Processed email inquiries for address updates, phone number changes, and primary care provider modifications, ensuring accurate record maintenance and prompt responses.
• Facilitated training sessions for new customer service advocates, guiding them through system navigation and call documentation procedures.: A support system for newly hired customer service advocates. Assisted with navigating the systems. The procedures on how to document incoming calls. How to access the knowledge base to find information for the specific type of call. To assist the member or provider with the reason for the call.

Pedi onboarding for groups and Individuals. End to End

Load new groups and individuals

Updated demographic data to ensure accuracy and reliability

Term providers. Add networks.

In PPW

Verified provider credentials and added providers and Pfins in QNXT for compliance

Add case numbers & Pfins in Getwork

Utilized Sales Force for customer relationship management

Created CRM in Salesforce to maintain detailed provider information

Retrieved data from company system and entered relevant information into secondary system.

Developed indexing strategies to enhance document retrieval efficiency.

Ensured data accuracy through meticulous review of indexed materials.

Collaborated with cross-functional teams to streamline indexing processes.

Retrieved and verified electronic orders from system, processed them for shipment, and coordinated email delivery to appropriate freezer for order fulfillment.

Processed revised purchase orders received via email or fax, ensuring accuracy and timely updates.

Self-motivated, with a strong sense of personal responsibility.

Worked effectively in fast-paced environments.

Skilled at working independently and collaboratively in a team environment.

Retrieved and organized data from system to support Producer Service Request. Created and attached Excel spreadsheets and Word documents to enhance Producer Service Request processing.

Processed high volumes of data entries with accuracy and attention to detail.

Maintained database integrity through regular audits and error correction initiatives.

Collaborated with team members to streamline data input processes, enhancing efficiency.

Welcomed visitors by greeting them in person or on the phone. Answering or referring inquiries. Scheduled meetings and reserved conference rooms to ensure effective use of office space. Managed office and kitchen supply inventory by coordinating orders with vendors for timely replenishment. Maintained mail deliveries and shipments. Processed Fed Ex shipments. Facilitated new hire security access to support onboarding and ensure compliance with security protocols. Processed all facility requests with building management.

Managed front desk operations, ensuring smooth visitor check-in and appointment scheduling.

Handled multi-line phone system, efficiently directing calls to appropriate departments.

Implemented filing systems to enhance document retrieval and office organization.

Scheduled patients for follow up appointments. Processed referrals and scheduled appointments for outpatient testing and procedures.

Retrieved and organized outpatient testing results from laboratories to support timely patient follow-up and care coordination.

Collected and interpreted data for grant reporting, ensuring accurate communication with affiliated hospitals and referral institutions to maintain continuity of care through timely faxing of medical records and documents.