Summary
Overview
Work History
Education
Skills
Volunteer Experience
Hobbies and Interests
Timeline
Generic

Mounika Goranthala

Airdrie,AB

Summary

Seeking a challenging position in a reputed organization where I can learn new skills, expand my knowledge, and leverage my learning’s. Secure a responsible career opportunity to fully utilize my training and skills, while making a significant contribution to the success of the company

Overview

10
10
years of professional experience

Work History

Customer Service Specialist

Tech-Mahindra
10.2023 - Current
  • Resolved concerns with products or services to help with retention and drive sales.
  • Addressed customer complaints and mitigated dissatisfaction by employing timely and on-point solutions.
  • Provided primary customer support to internal and external customers.
  • Took payment information and other pertinent information such as addresses and phone numbers to place orders.
  • Achieved high satisfaction rating through proactive one-call resolutions of customer issues.
  • Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
  • Offered internal and external customers first-rate customer service to maximize satisfaction and business success.
  • Promote Rogers products and services. • Take appropriate action to efficiently resolve issues. • Identify customers need for additional Rogers's products and services. • Take accountability to solve issues from beginning to end. • Meet established productivity objectives. • Receive and incorporate feedback to improve personal and business performance.
  • Take ownership to resolve customer issues from the beginning to end.
  • Work with a supportive and dynamic leadership team that will encourage your growth and development.
  • Offering assistance to customers to ensure they find the right product/service. Communicating with customers by email, phone, and face-to-face. Investigating and solving customer problems
  • Working with clients who have complaints, orders, or require information about products/services purchased from the organization. They also provide solutions that fit


Customer services Specialist

Tech-Mahindra (Manulife)
05.2022 - 04.2023
  • Detail orientation, technical details, following established processes and assisting with the development of new or changes to support process, assisting with the development of new or changes to support process, Customer service, problem-solving, communication, data entry, attention to detail, research, organizational skills, and time management
  • Responsible for preparing claim forms, verifying information, and corresponding with agents and beneficiaries
  • You will also handle client inquiries, review policies, determine coverage, calculate claim amounts, and process payments
  • Processing medical record requests and reviewing the secondary and tertiary claims for legitimacy
  • Learned Dental coding and specific services provided by dentists
  • Received training in Orthodontics, Periodontal procedures and charting
  • Responsible for all Training through on line CBTs and daily Ques completed
  • Maintained high level of production and balance accuracy
  • Responsible for correcting and Rebutting all audit errors
  • Sending invoices for payment, coding medical services, diagnoses, procedures, treatments, tracking payments, and following up with concerned parties on rejected claims and outstanding bills
  • Customer support specialist Techmahindra Rogers
  • Take ownership to resolve customer issues from the beginning to end
  • Work with a supportive and dynamic leadership team that will encourage your growth and development
  • Offering assistance to customers to ensure they find the right product/service
  • Communicating with customers by email, phone, and face-to-face
  • Investigating and solving customer problems
  • Working with clients who have complaints, orders, or require information about products/services purchased from the organization
  • They also provide solutions that fit those individualized situations and prioritize the customers' needs at each step of the process
  • Being attentive, understanding, professional, and going the extra mile to meet customer expectations
  • It means actively listening to customers, understanding what they need, and delivering reliable solutions to make them happy and keep them coming back
  • Promote Rogers products and services
  • Take appropriate action to efficiently resolve issues
  • Identify customers need for additional Rogers's products and services
  • Take accountability to solve issues from beginning to end
  • Meet established productivity objectives
  • Receive and incorporate feedback to improve personal and business performance.

Customer Service Management

Loblaw Limited
03.2020 - 03.2023
  • Assisted claim adjusters by timely and accurately recording and processing over 500 property damage claims per month
  • Provided on-going customer support for dealers and customers, resulting in increased satisfaction and retention
  • Supported internal insurance agents by managing telephone inquiries, processing outbound mail, maintaining customer records, and administering to customer and dealer requests
  • Recognized the potential of possible fraudulent claims; submitting to the special investigations unit with close monitoring
  • Analyzed bills for authorization of delay, denial or payment; opening reserves on the file to reflect the extent of injuries
  • Thoroughly investigating, evaluating and negotiating insurance claims to a proper conclusion
  • Adhered to regulatory compliance guidelines for enterprise & departmental producers
  • Follows the established process and uses all tools necessary to be effective, efficient and productive
  • Evaluating and negotiating settlements of claims within policy limits
  • Awarded for receiving 100% accuracy on referrals to the Special Investigation Unit on suspected insurance fraud
  • Preparing root because analysis and improvement plan for critical defects.

Customer Service/Business analyst/BPO, Sales specialist

Skean Limited
11.2018 - 10.2019
  • Implements sales strategy, new business/membership/client development, retention of clients/members, negotiation of contracts, and identification of entrepreneurial enterprises and relationship management strategies
  • Troubleshooting customer issues, providing data and guidance to the sales team, managing sales tracking tools, and analyzing sales trends
  • They liaise with account managers, stay updated on product launches, and suggest sales process improvements
  • Submitting quotes, tracking orders, solving customer issues and providing information about products
  • Ensure current customers have the right products and services, identify new markets and customer leads, and pitch prospective customers
  • Training and onboarding
  • Handling sales issues
  • Coordinating the sales team and assisting with recruiting and training new hires
  • Providing product demonstrations to staff and clients, and taking the lead in resolving complaints
  • Analyzing sales team performance and scheduling training/refresher sessions accordingly
  • Conducting market research and sharing findings with the team
  • Working alongside the team to draw up strategies to increase customer base
  • Setting sales targets and implementing incentives
  • Providing accurate sales forecasts and allocating resources so targets are met
  • Managing a network of vendors and suppliers
  • Meet deadlines for reporting and multitasking with multiple client instructions
  • Independent work environment requiring responsibility, time management, and organization
  • Xactimate estimate software experience
  • Maintaining excellent relationships with customers that are built on trust, and encouraging the rest of the sales team to follow this example
  • Keeping up-to-date with advancements in marketing.

Revenue-Cycle Analyst, Healthcare Claim Representative

Sutherland Global Services
10.2013 - 10.2018
  • Analyzed each claim to make sure that they followed proper guidelines and procedures
  • Familiar with co pay, coinsurance, in -network and Out of network Providers
  • COB (Coordination of benefits) and EOB (Explanation of benefits)
  • Maintain on-going communication with insurer/adjuster to obtain status updates and claims reserves/payments, as instructed by the Claims Advisor
  • Perform claims tasks as assigned by Claims Advisor
  • Monitor email correspondence relating to claims reported by to our After Hours Emergency service to identify appropriate claims team within BFL
  • File information electronically in accordance with claims procedures
  • Maintain claims accounts with various electronic claims platforms with insurers
  • Prepare and circulate monthly claims meeting minutes
  • Update claims procedures, as required
  • Receive incoming mail and attach to appropriate file in EPIC
  • Prepare Loss Run/History for client executive teams as required
  • Prepare claims bordereaux as required for specific clients
  • Assist with preparation of claims presentations
  • Receive cheques and prepare correspondence to deliver payments on appropriate claim
  • Called primary insurances for eligibility/benefits/Authorization etc
  • Maintaining Hipaa guidelines, Ensure the confidentiality, integrity, and availability of all e-PHI they create, receive, maintain or transmit; Identify and protect against reasonably anticipated threats to the security or integrity of the information; Protect against reasonably anticipated, impermissible uses or disclosures
  • Was responsible for filing each claim and keeping the claim archive accessible
  • Created a monthly report for management on the financial status of outstanding and paid claim
  • Knowledgeable on the laws and rules regarding medical claims
  • Assisted medical providers with medical claims status and patient eligibility/ benefits information
  • Responded to provider’s requests regarding Explanation of Benefits (EOB) by using Right Fax
  • Handled escalated calls and made sure their needs were being met from a supervisory perspective
  • Reviewed insurance policy to determine coverage and provided quality service
  • Prepared insurance claim forms or related documents and review them for completeness
  • Provided customer service, such as limited instructions on proceeding with claims or referrals to medical providers
  • Organized or worked with detailed office records, using computers to enter access, search or retrieve data
  • Processed claim forms, adjudicating for allocation of deductibles, co-pays, co-insurance maximums and provider reimbursements
  • Followed adjudication policies and procedures to ensure proper payment on claims.

Education

Bachelor's - Pharmacy

Jawaharlal Nehru Technological University (Hyderabad, India)
01.2013

Skills

  • Accomplished accounts payable specialist with a high degree of professionalism and strong problem resolution capabilities Maintains 100% accuracy in processing invoices Proficient at vendor manage
  • Provided administrative support to physicians and interpret data to assign ICD-9
  • Sales Specialist
  • Good knowledge on Cpt codes for Health and Dental also Medicare and Medicaid guidelines
  • Aware of Hipaa Act
  • Coverage assessments
  • Quality standard skills
  • Documentation
  • Liability
  • Entered CPT Codes and patient information into billing software
  • Reviewed and validated accuracy of charges including dates of service, services provided, location and provider signature
  • Copy writing
  • Typing speed of 60 wpm
  • Extensive knowledge of insurance-related policies and legislation
  • Proficient in analytical math
  • Excellent conflict resolution skills

Volunteer Experience

Child Care Home, Assist once per month with the after-school reading program.

Hobbies and Interests

  • Browsing
  • Cooking
  • Gardening
  • Participating In Social Work

Timeline

Customer Service Specialist

Tech-Mahindra
10.2023 - Current

Customer services Specialist

Tech-Mahindra (Manulife)
05.2022 - 04.2023

Customer Service Management

Loblaw Limited
03.2020 - 03.2023

Customer Service/Business analyst/BPO, Sales specialist

Skean Limited
11.2018 - 10.2019

Revenue-Cycle Analyst, Healthcare Claim Representative

Sutherland Global Services
10.2013 - 10.2018

Bachelor's - Pharmacy

Jawaharlal Nehru Technological University (Hyderabad, India)

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Mounika Goranthala