KC User

Greeted customers, answered questions, and provided guidance during checkout. Processed checkout and return transactions, bagged items, and issued receipts. Maintained a safe and organized area, including the self-checkout area, and followed all policies and procedures to minimize shrink and ensure inventory accuracy.

Established high-quality customer relationships using informational resources and technical knowledge. Handled a high volume of inbound customer and sales agent inquiries. Communicated and educated on product features, benefits, and contract provision details.

Processed claims and moved to the Warrant Department to process warrants and injunctions. Answered phone calls from various law enforcement agencies and civilians.

Guided insureds and claimants through the auto claims process from start to finish. Investigated liability by consulting with witnesses, reviewing police reports, and compiling evidence. Determined policy coverage through analyzing investigation data and policy terms, notifying insureds of coverage or issues.

Processed requests and responses for pharmacy prior authorizations, communicating approval or denial. Handled inbound and outbound phone calls, receiving, sorting, and distributing incoming mail and electronic fax requests. Facilitated resolution of drug coverage issues and addressed, researched, and resolved issues while maintaining accurate documentation.

Maintained office services by organizing operations and procedures, preparing payroll, and controlling correspondence. Prepared work assignments for staff, supervised staff, and managed office equipment. Occasionally assisted in the field when manpower was short.

Oversaw day-to-day operations of the facility, ensuring site safety and security, and implementing site policies and procedures. Conducted regular inspections and maintenance of systems and equipment, monitoring fire alarm control panels and other emergency equipment. Supervised and evaluated staff, completing employee reviews, and maintaining accurate records of attendance and timesheets.

Took inbound calls from members, providers, and third-party vendors, explaining benefits and claims. Discussed how to file appeals and complaints, and resolved complex customer service inquiries related to benefit and eligibility information, billing, and payment issues.

Made outbound calls and answered incoming calls from customers to assess their needs and build comprehensive solutions. Provided general information about Humana's products, value, and rates to prospective customers. Educated customers, providers, and employers about products and services.

Assisted clients with questions, concerns, and problems, offering solutions regarding insurance policies, billing, payments, and plan changes. Provided expertise and general claims support by reviewing, researching, investigating, negotiating, processing, and adjusting claims. Analyzed and identified trends, providing reports as necessary.

Identified and referred sensitive cases to the appropriate authority and skill level. Answered policyholder inquiries pertaining to policy coverage and premium. Provided quotes, refunds, and corrected policies, resolving complaints or inquiries involving rates and surcharges.

Reviewed claims notices and medical reports to determine coverage expense as specified in the policy. Handled inquiries from providers, employees, and other major insurance companies.

Computed benefits by screening and interpreting medical bills. Processed claims by entering appropriate information into the system to make payments or request additional information. Processed medical, dental, Medicare, Medicaid, and prescription claims.

Gave authorization to merchants based on restrictive guidelines and lack of negative customer information. Assessed loss of profit due to accuracy of provided document information. Checked documents for fraudulent information such as forgeries, alterations, or invalid details.

Completed some college coursework, accumulating 25 credits. Studied various subjects at the community college level. Gained foundational knowledge in general studies.

Obtained a high school diploma. Completed general education requirements. Prepared for further academic or professional pursuits.