Summary
Overview
Work History
Education
Skills
Languages
Timeline
Hobbies and Interests
Generic

Emily Sword

Summary

Experienced professional in group health benefits, claims adjudication, customer service, and healthcare support. Skilled in managing patient/client information, handling sensitive data, and improving customer experience. Eager to contribute expertise, passion, and positivity to this role. Looking forward to discussing this exciting and challenging position further.

Overview

23
23
years of professional experience

Work History

Receptionist & Patient Care Coordinator

Dolman Eyecare Centre
03.2024 - Current
  • Greet and check in patients for scheduled appointments, ensuring accurate and error-free patient information.
  • Manage walk-in patients and oversee patient scheduling for 3-5 doctors.
  • Handle inventory, ordering, receiving, and selling eye care products (e.g., eye drops, vitamins).
  • Process patient payments and provide invoicing via paper or email.
  • Maintain patient privacy and confidentiality at all times.
  • Implemented Missed Appointment/No Show policy, improving patient attendance.
  • Manage Eye See Eye Learn (ESEL) reporting, filing, and processing.
  • Perform triage, verify OHIP eligibility, and book appointments.
  • Maintain clinic cleanliness, ensuring waiting rooms and exam areas are stocked and sanitized.

Receptionist

MK Martin Enterprise Inc.
10.2023 - 03.2024
  • Answered inbound calls and directed to appropriate departments.
  • Managed office supply orders, returns, and invoicing to customers.
  • Processed accounts payable invoices and managed bank deposits.
  • Created purchase orders and assisted with month-end project WIP receipts.
  • Maintained office organization, including calendar updates and various office errands.

Service First Contact Centre (CSR)

Region of Waterloo
01.2023 - 10.2023
  • Answered inbound calls, assisting citizens with service inquiries and concerns.
  • Managed service requests for housing, transportation, waste management, and other services.
  • Provided detailed information on community programs and government services.
  • Collaborated with various departments to forward citizen concerns and requests.
  • Delivered exceptional customer service while adhering to corporate policies and legislation.

Technical Referral Analyst, Drug Prior Authorization, Health Claims Adjudication & Dental Customer Service Representative

Manulife
01.2003 - 01.2023
  • Provided health benefits and claims support, including researching and presenting information for benefit updates.
  • Mentored and coached colleagues to reduce unnecessary referrals and improve decision-making.
  • Assessed high-cost drug claims and gender affirmation surgery requests, ensuring accurate processing.
  • Collaborated across teams to enhance customer experience and improve operational efficiency.
  • Demonstrated expertise in managing medical and claims-related inquiries, maintaining privacy, and ensuring compliance.
  • Use of lotus Notes for claims processes, investigation and research
  • Researched, compiled, and presented information to Product to request the addition of Breast Pumps to the Standard medical equipment benefit for all blocks of business. Outlining the medical necessity of this device for parents and newborns.
  • Focused on Continuous improvements to enhance the customer experience.
  • Reasonable and customary rates reviewed annually for Paramedical practitioner fees by province and practitioner type.
  • Communication with Underwriting or Account Executives for intent of benefits or limitations on the contract elected by the Plan Sponsors (Employers).
  • Coaching, mentoring claims adjudicators to reduce unnecessary referrals and empowering adjudicators in making decisions.
  • Applied to the Leadership Development Program within Manulife on LinkedIn Learning. Continuous learning through LinkedIn programs.
  • Participation or presentation of information in referral meetings and to other departments.
  • Accurately reviewing and processing claims between $20,000-$49,999 with attention to details of the policy.
  • Gender affirmation surgery claims and out of province or out of country claim processing.
  • Participation in focus groups as it relates to the group benefits organization. Most recent focus group – Philips Recall and Reducing Referrals.
  • Accurately assessing requests for high cost and/or limited use drugs as per criteria outlined in Manulife Claims, TECH manuals and policy provisions.
  • Using the Health Canada product monograph to confirm new indications or clinical uses of a drug.
  • Speaking with Health Care professionals, patients, program coordinators to obtain and verify information.
  • Focused on customer centricity and the customer experience.
  • Empathy for patients and their medical situations.
  • Privacy and confidentiality with all patient information.
  • Working with outside programs on behalf of our clients (i.e., Bayshore, ADP, provincial plans)
  • Adapting to daily changes in the pharmaceutical world to correctly assess drug requests.
  • Deciphering and understanding medical information and acronyms submitted to fully understand customer situations.
  • Data entry and coding on ESC – Express Scripts pharmacy system
  • Collaboration between Prior Authorization Team, TECH services, Customer Service, and other departments to reach a decision for the client.
  • Developed a medical acronym document that was added to the claim’s manual.
  • Proficient in Excel (not coding), MS Word, TEAMS, One Note and have used Power point. Use of 3 internet search engines daily.
  • Collaboration with team, peers, other departments to improve the customer experience.
  • Ensure that every need of the customer/client is met in a timely fashion with accuracy and within the agreed turn-around time for response.
  • Effective communication skills both oral and written
  • Mentoring, answering questions, explaining processes, checking work for the new hires, and assisting them to feel comfortable in the environment and claim adjudication field.
  • Answer telephone calls in a timely fashion, identify the problem or need, listen to the client, and resolve the matter.
  • Assist clients with understanding their benefits and confirming their coverage
  • Work from Home since 2010

Education

Diploma - Personal Support Worker (PSW)

St. Lawrence College
Kingston, ON
01.1998

High School Diploma - undefined

Sydenham High School
Sydenham, ON
01.1996

Skills

  • Claims Adjudication and Medical Terminology
  • Data Entry and Documentation
  • Customer Service and Client Care
  • Inventory Management and Sales
  • MS Office Suite (Word, Excel, PowerPoint, OneNote)
  • Google Applications
  • Privacy and Confidentiality Compliance
  • Team Collaboration and Mentoring
  • Organization skills
  • Time management
  • Telephone skills
  • Data entry

Languages

English
Native or Bilingual

Timeline

Receptionist & Patient Care Coordinator

Dolman Eyecare Centre
03.2024 - Current

Receptionist

MK Martin Enterprise Inc.
10.2023 - 03.2024

Service First Contact Centre (CSR)

Region of Waterloo
01.2023 - 10.2023

Technical Referral Analyst, Drug Prior Authorization, Health Claims Adjudication & Dental Customer Service Representative

Manulife
01.2003 - 01.2023

High School Diploma - undefined

Sydenham High School

Diploma - Personal Support Worker (PSW)

St. Lawrence College

Hobbies and Interests

Enjoy outdoor activities, including walking and nature excursions. Active member of the Legion and involved in darts with my husband. Support and engaged in my children’s extracurricular activities. Spending time with my family and our dogs.

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Emily Sword