Summer Wright
Troutville
Summary
Well-qualified support professional with positive and friendly demeanor. Strong attention to detail, effective communication skills and solid history of tackling diverse and challenging requirements. Well-versed in medical administration and insurance.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Policyholder Support Specialist II
The Standard Acquisition of Anthem Life and Disability
04.2024 - Current
- Work in a fast paced, high volume production environment accurately and with a strong sense of urgency to make complex billing changes and set up paper and electronic files for complex cases to enable downstream customers to process requests
- Provide superior customer service to internal and external customers
- Answer basic to complex inquiries
- Respond to written correspondence
- Counsel and assist customers in the resolution of member billing inquiries, initial set up and delivery of new cases, policy amendments, policy conversions, and other issues, or escalate appropriately
- Communicate and coordinate with appropriate home and field office employees to identify and implement satisfactory solutions to customer service matters
- Provide information regarding data feeds and downloads for system administration and IT departments of payroll providers and group IT administrators
- Provide complex administrative support for the customer service department, including but not limited to contract mail outs, certificate request processing, Creating Invoices, processing address changes made in primary main frame systems
- Analyze and research exception reports created by system limitation or input errors
- Take corrective action based on research to ensure the integrity of customer bills
- Maintain other reporting records as needed
- System administration for electronic data feeds, formatting excel documents for encryption and download QA input of member information to billing and BenDes systems to ensure integrity of data and provide superior customer service.
Eligibility and Enrollment Specialist 1
Elevance Health
08.2023 - 03.2024
- Screens all forms received for accuracy
- Verifies enrollment status, makes changes to records, research, and resolves enrollment systems rejections; addresses a variety of enrollment questions and/or concerns received by phone or mail
- May initiate outgoing calls to employer groups, brokers and sales representatives to answer benefit questions, resolve issues and educate callers
- Make requests to Underwriting, Sales or Brokers for missing information and/or forms
- Recognize when benefits are non-standard and requests assistance for handling appropriately
- Thoroughly documents inquiry outcomes for accurate tracking and analysis
- Develops and maintains a positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled within a timely manner
- Handles basic medical evidence underwriting
- Must be able to consistently average 98% quality on phone and enrollment audits within 90 days of completed training
- Must maintain 48-hour TAT on emails within 90 days of completing training
- Performs basic job functions with help from co-workers, specialists and managers on non-basic issues
- Adherence to Attendance Policy and all other company policies and guidelines.
Human Resource Manager
A Shining Light, Inc
12.2021 - 02.2023
- Opening the corporate office during daily business hours
- stocking office supplies that are needed
- responsible for ensuring the corporate office is maintained daily/weekly
- checking mail daily
- answering the corporate telephones and managing the daily office on-call questions from the residential and community staff
- must have knowledge of all three schedules; responsible for knowing and operating the Data A Server system
- responsible for employee payroll items
- putting together employment manual/new hire packets
- assisting in the application process
- setting up employee field print;
- Managed employee relations issues professionally, resolving conflicts efficiently while maintaining confidentiality at all times.
- Maintained accurate HR records in compliance with applicable laws, ensuring efficient data retrieval when required.
Service Director
A Shining Light, Inc
02.2021 - 08.2021
- Medical management of 4 client scheduling, transportation and communicating with physicians/specialist
- Quality assurance of all medications, placement of medications, monthly updates to ensure physicians’ orders, drug information, and health in services for monthly staff education
- Corresponded with guardians/authorized representatives regarding Physical and Mental Concerns
- Maintaining documentation such as Physician Orders, Face Sheet updates, Authorized release, appointment summary forms and medical case notes
- Completed weekly audits on medication administration records, handled all errors accordingly, as well as ensured the stock of scheduled, PRN and house stock medications.
Office Manager
A Shining Light, Inc
11.2019 - 01.2021
- Organized employee files
- Documentation within employee and client files for audits
- Obtained receipts for filing when using company cards
- Scanned documents into clients charts
- Managed office area
- Managed multi-line phone
- Management schedules and training
- On-call provider to direct support staff
- Scheduled interviews
- Helped create new hire schedules and training packets
- Medicaid Reimbursement Billing
- Completed money audits for each group home.
Medical Office Associate
Carilion Clinic
01.2015 - 01.2019
- Accepted and processed customer payments in cash, check and credit cards
- Acknowledged customer issues and resolved their problems quickly and efficiently
- Effectively communicated with other employees and upper management to ensure complete care of customers
- Evaluated the customers’ needs and provided service options to meet their requirements
- Fulfilled administrative duties, including, completing and filing paperwork, directing a multi-line phone and setting appointments.
- Maintained a welcoming environment for patients by ensuring cleanliness and organization in waiting areas and exam rooms.
- Contributed to the success of quality improvement projects within the practice by identifying inefficiencies in processes and recommending solutions that positively impacted patient outcomes.
- Ensured compliance with HIPAA regulations through diligent management of patient information and strict adherence to confidentiality policies.
- Improved patient care coordination by proactively communicating with insurance companies, laboratories, and other specialists.
Education
Certificate - Health Administration
Ashworth College
Norcross, GA07-2020
High School Diploma - General Studies
James River High School
06-2010
Skills
- Customer support services
- Customer service optimization
- Strong organizational abilities
- Knowledge of clinical terminology
- Effective time management
- Steadfast in responsibilities
- Strategic issue resolution
- Effective documentation and reporting
- Dependable team member
- Skilled in Microsoft Office applications
References
- Mickie Etzler, 540-793-3060
- Crystal Bennett, 832-917-7449
- Sarah Howell, 513-594-9412
Certification
- CNP - Certified Notary Public
- Life, Health and Annuity, Insurance Producer License
Timeline
Policyholder Support Specialist II
The Standard Acquisition of Anthem Life and Disability
04.2024 - Current
Eligibility and Enrollment Specialist 1
Elevance Health
08.2023 - 03.2024
Human Resource Manager
A Shining Light, Inc
12.2021 - 02.2023
Service Director
A Shining Light, Inc
02.2021 - 08.2021
Office Manager
A Shining Light, Inc
11.2019 - 01.2021
Medical Office Associate
Carilion Clinic
01.2015 - 01.2019
Certificate - Health Administration
Ashworth College
High School Diploma - General Studies
James River High School
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