SHAYLA PROFESSIONAL SUMMARY

SMITH
Caring Patient Advocate with a successful background working as a
positive intermediary between hospitals and patients undergoing
treatment. Excellent communication and problem-solving abilities.
Bringing 3 years of experience in the field. Capable Patient
Representative dedicated to providing superior support for patients in
shaylazhane26@icloud.com
need of reliable information regarding insurance coverage, finance
options and documentation requirements. Well-versed in scheduling and
803-317-4276
database management functions for streamlined communication and
reduced correspondence backlogs. Excels at identifying client needs
Leesville, SC 29070
and concerns to improve engagement strategies and overall service.
Responsible Data Specialist bringing abundant experience from varying
data entry settings. Well-coordinated and detail-oriented in addressing
and resolving system issues to complete assignments. Decisive and
analytical problem-solver. Dedicated Customer Service professional with
knowledge of service delivery and proven multitasking abilities.
Committed to maintaining professional relationships to increase
profitability and drive business results. Passionate about promoting
lasting customer satisfaction by delivering quality service and
unparalleled support. Proficient in customer service best practices and
related options.

SKILLS WORK HISTORY

• Quality Assurance UnitedHealth Group - Care Advocate
• Patient Correspondence Remote • 07/2020 - Current
• Victim Advocacy
• Researched issues and took appropriate action to resolve issues
• Reviewing Patient Information
within turnaround time requirements and quality standards.
• Customer Care
• Assisted in completing and maintaining care management contracts
• Medicare Knowledge
during and after patient's hospitalization.
• Technical Assistance
• Prepared documents and reports for clinical reviews and discharge
• Benefits Verifications
plans.
• Database Coordination
• Documented activities and progress in electronic medical record per
• Resource Utilization
defined policy and procedures.
• Caseload Management
• Entered timely and accurate data into electronic medical records to
• Inpatient Care
communicate member needs.
• Medical Consultation
• Conducted patient assessments to determine appropriate levels of
• Care Improvement
care.
• Proactive Problem-Solving
• Met with community providers to foster good rapport and
• Patient Advising
relationships and identify new programs.
• Insurance Understanding
• Contacted third-party payors to obtain and confirm authorization for
• Referral Processing
services and communicated necessary related clinical information.
• Hospital Patient Screening
• Participated in facility meetings with treatment team to develop
• Credit Card Payment Processing
successful aftercare plans.
• Sales Expertise
• Worked with enrollees to identify gaps in care or obstacles to care.
• Microsoft Excel
• Followed document protocols to safeguard confidentiality of patient
• Microsoft PowerPoint
records.
• Microsoft Word
• Facilitated communication between patients and various
• Retail Sales Customer Service
departments and staff.
• System Implementation
• Applied administrative knowledge and courtesy to explain
• Standard Operating Procedures
procedures and services to patients.
 Proficient • Kept current with literature and felid advancements to advocate to
• Data Acquisition and for patients.
• Word Processing • Recommended service improvements to minimize recurring patient
• Excel Expertise issues and complaints.
• Monthly Closings • Worked with patients to ascertain issues and make referrals to
• Data Transcription appropriate specialists.
• Data Auditing • Helped address client complaints through timely corrective actions
• Data Collection and appropriate referrals.
• Data Processing • Organized patient records and database to facilitate information
• Error Identification storage and retrieval.
• Data Input • Offered simple, clear explanations to help clients and families
• Efficient Data Entry understand hospital policies and procedures.
• Transcribing Documents • Taught patients and families to use at-home medical equipment.
• Compiling Data • Precisely evaluated and verified benefits and eligibility.
• Market Research Data Entry • Examined patients' insurance coverage, deductibles, insurance
• Typing Manuscripts carrier payments and remaining balances not covered under policies
• Accounts Payable and Accounts when applicable.
Receivable • Posted and adjusted payments from insurance companies.
• Determined prior authorizations for medication and outpatient
procedures.
EDUCATION • Evaluated patients' financial status and established appropriate
payment plans.
Gilbert High School • Prepared billing correspondence and maintained database to
Gilbert, SC organize billing information.
High School Diploma • Printed and reviewed monthly patient aging report and solicited
overdue payments.
• Delivered timely and accurate charge submissions.
• Filed and updated patient information and medical records.
• Pre-certified medical and radiology procedures, surgeries and
echocardiograms.
• Communicated with insurance providers to resolve denied claims
and resubmitted.
• Collected payments and applied to patient accounts.

BlueCross BlueShield Of SC - Customer Service Representative

Columbia, SC • 01/2018 - 05/2020
• Maintained customer satisfaction with forward-thinking strategies
focused on addressing customer needs and resolving concerns.
• Answered customer telephone calls promptly to avoid on-hold wait
times.
• Answered constant flow of customer calls with minimal wait times.
• Offered advice and assistance to customers, paying attention to
special needs or wants.
• Assisted customers with setting appointments, special order
requests, and arranging merchandise pick-up.
• Provided primary customer support to internal and external
customers.
• Responded to customer requests for products, services and company
information.
• Recommended products to customers, thoroughly explaining details.
• Followed up with customers on unresolved issues.
• Reviewed new files to determine current status of injury claim and
to develop plan of action.
• Conducted full claim investigations and reported updates and legal
actions.
• Utilized appropriate cost containment techniques to reduce overall
 claim costs.
• Modeled exceptional customer service skills and appropriate
diagnostic sales techniques to team members.
• Escalated files with significant indemnity exposure to supervisor for
further investigation.
• Reported policy changes and company conditions affecting customer
satisfaction.
• Implemented improvements in manual and electronic billing
procedures.
• Addressed an average of 500 customer inquiries and complaints each
week.
• Completed onsite Xactimate estimates with photos and narrative
reports.
• Conducted day-to-day administrative tasks to maintain information
files and process paperwork.
• Examined claims forms and other records to determine insurance
coverage.
• Read over insurance policies to ascertain levels of coverage and
determine whether claims would receive approvals or denials.
• Reviewed police reports, medical treatment records and physical
property damage to determine extent of liability.
• Researched claims and incident information to deliver solutions and
resolve problems.
• Delivered exceptional customer service to policyholders by
communicating important information and patiently listening to
issues.
• Resolved complex, severe exposure claims using high service
oriented file handling.
• Conducted comprehensive interviews of witnesses and claimants to
gather facts and information.
• Identified insurance coverage limitations with thorough
examinations of claims documentation and related records.
• Investigated and assessed damage to property and reviewed
property damage estimates.
• Determined liability outlined in coverage and assessed
documentation such from police and healthcare providers to
understand damages incurred.
• Analyzed information gathered by investigation and reported
findings and recommendations.
• Analyzed information gathered by investigation and reported
findings and recommendations.
• Maintained contact with claimants and attorneys to determine
treatment status.
• Reviewed questionable claims by conducting agent and claimant
interviews to correct omissions and errors.
• Conducted thorough property investigations to identify and classify
damages for customer claims.