I have six years of experience supporting a U.S. healthcare account in the BPO industry. Throughout my career, I gained extensive experience in customer service, healthcare support, agent coaching, and quality assurance.
I assisted members (patients) and healthcare providers—including physicians' offices, nurses, hospitals, clinics, and other medical professionals—with a wide range of healthcare-related inquiries. I managed 20+ inbound calls daily, helping customers with claim status, insurance eligibility and benefits, prior authorizations, referrals, appeals, and grievances. I also explained claim payments, denials, and coverage based on members' health plans while ensuring compliance with company policies and delivering excellent customer service.
In addition, I became knowledgeable in interpreting CPT, HCPCS, and J-codes, as well as Remittance Advice (RA) documents, enabling me to clearly explain claim payments, adjustments, denials, and reimbursement details to both members and providers.
As my experience grew, I began supporting both new and tenured agents by answering process-related questions, resolving complex healthcare inquiries, handling escalated calls, and providing real-time coaching during nesting. I shared best practices, clarified policies, and helped improve team productivity while ensuring compliance with company guidelines.
Later, I transitioned into quality assurance, where I conducted 80 call quality evaluations each week (two audits per week for 40 agents). I monitored customer interactions for compliance with client standards, identified coaching opportunities, analyzed performance trends, and provided actionable feedback to improve agent performance, service quality, and the overall customer experience.
Quality Assurance Specialist | Customer Service Professional | Insurance Verification | HIPAA Certified | 5 years + Experience in Healthcare Industry | Healthcare Virtual Assistant
