Overview
Work History
Education
Skills
Timeline
Generic

Sheldon Johnson

Grande Prairie,TX

Overview

14
14
years of professional experience

Work History

CX Agent

Sedwick
Memphis, TN
01.2022 - Current
  • Processed auto property damage; assesses damage, makes payments, and ensures claim files are properly documented and correctly coded based on the policy.
  • Processed incoming calls, faxes and voicemails from claimants, providers, clients, attorneys, etc., resolving their claims related questions and issues in accordance with designed guidelines and policies.
  • Communicated claims status and current claim activity with client and appropriate medical contact; responds to inquiries about jurisdiction- and claim-specific issues.
  • Entered data into claims system(s) and ensures claim files are properly documented and claims coding is correct.
  • Provided referrals to legal, utilization review, pharmacy, and Special Investigations Unit (SIU) as appropriate and coordinates independent medical examinations.
  • Enters data into claims system(s) and ensures claim files are properly documented and claims coding is correct.

Customer Service Advocate

Blue cross blue shield
Lake Mary, FL
07.2018 - 10.2021
  • Helped ensure all customers (walk-in, telephonic or electronic) are warmly greeted, their needs are assessed quickly, and they are referred to the appropriate setting, person, information, or tools to address their needs.
  • Provided a customer friendly service experience for customers with questions or issues related to health care, health insurance (benefits, claims, premium payments, membership, billing, and enrollment) or other related topics.
  • Served as direct contact and subject matter expert for questions from the public or existing members related to Health Care Reform.
  • Conducted orientations for new customers, explaining resources, services, and programs as appropriate.
  • Explained/promoted incentive programs to target customers or prospects, building enthusiasm and support for program participation and answering questions.
  • Ensured service coordinated with other supporting areas maintains the appropriate retail center service experience and that internal complexities remain invisible to the customer

Member Service Representative

Health First
Orlando, FL
02.2015 - 07.2018
  • Received and processed referrals from Hospitals, Provider offices, Rehab’s, etc., and maintain frequent communication about delivery of setups.
  • Collected all current and past-due patient responsibility balances prior to services being rendered.
  • Verified patient’s insurance eligibility utilizing assigned tools, updates information in patient’s account as needed.
  • Obtained demographic and insurance information from patient and inputs data accurately into the patient management system.

Customer Service Representative

Convergys At HOme
Orlando, FL
04.2010 - 04.2012
  • Worked in the inbound call.
  • Assisted customers via live chat.
  • Client knowledge of product and services.
  • First Contact Resolutions.
  • Processed upgrades and payments.

Education

Associate of Science - ConvergysSedwickHealthcare Administrations

University of Phoenix
Online
05-2012

High School Diploma -

Cocoa High Scool
Cocoa, FL
05-2005

Skills

  • Customer Service Abilities
  • Lead Prospecting
  • Problem-Solving Skills
  • Call Management

Timeline

CX Agent

Sedwick
01.2022 - Current

Customer Service Advocate

Blue cross blue shield
07.2018 - 10.2021

Member Service Representative

Health First
02.2015 - 07.2018

Customer Service Representative

Convergys At HOme
04.2010 - 04.2012

Associate of Science - ConvergysSedwickHealthcare Administrations

University of Phoenix

High School Diploma -

Cocoa High Scool

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Sheldon Johnson