Artashia Richardson
Hattiesburg
Summary
Results-driven Member Service Advocate with three years of experience enhancing customer satisfaction and loyalty. Expert in conflict resolution and customer relationship management, effectively addressing inquiries and concerns. Proven ability to communicate clearly and build rapport, ensuring positive experiences for Medicare beneficiaries. Committed to delivering high-quality support in fast-paced call center environments. An organized and motivated individual, eager to utilize time management and organizational skills across diverse settings. Seeking entry-level opportunities to enhance abilities while contributing to company growth. Experienced in fast-paced environments and adaptable to last-minute changes. Thrives under pressure and consistently earns high marks for work quality and speed. Dedicated and adaptable professional with a proactive attitude and the ability to learn quickly. Strong work ethic and effective communication skills. Eager to contribute to a dynamic team and support organizational goals.
Overview
5
5
years of professional experience
Work History
Member Service Advocate
Foundever
Nashville
08.2025 - Current
- Assisted customers with inquiries and resolved service issues effectively.
- Delivered prompt and courteous responses to member inquiries and concerns, ensuring a positive service experience.
- Engaged in conversation with customers to understand needs, resolve issues and answer product questions.
- Assisted members in troubleshooting account issues and effectively using internal systems for their routine banking needs.
- Processed account changes and transactions accurately in the system.
- Maintained detailed records of customer interactions and feedback diligently.
- Resolved escalated issues and complaints efficiently.
- Advised customers on best practices for managing their accounts, including loan repayment options and budgeting strategies.
- Responded to member inquiries regarding available products and services at the bank.
- Educated members on the features and benefits of various account types available at the bank.
- Identified process improvement opportunities in member services to enhance efficiency and member satisfaction.
- Performed periodic reviews of customer accounts to detect any potential fraud or suspicious activities.
- Managed customer conflicts and challenging situations by staying calm and accessing internal knowledge -bases to develop strategic solutions.
- Consulted with customers regarding needs and addressed concerns.
- Achieved goals for member experience, transaction accuracy and product cross-sell, resulting in consistent growth.
- Exceeded established service goals while leveraging customer service, sales, and employee management best practices.
- Facilitated training sessions for new employees regarding policies and procedures related to member services operations.
- Suggested product and service enhancements to management, contributing to proactive solutions for member billing issues.
- Provided top quality control and eliminated downtime to maximize revenue.
- Prevented key account losses by researching discrepancies and correcting problems.
- Determined accurate prices for customer services, consistently searching for deals and best prices.
- Contacted customers about potential service upgrades, new services and account changes.
Patient Account Representative/ Medical Receptionist
Southeast Mississippi Rural Health Initiative
06.2024 - 07.2025
- Constantly demonstrates a strong working knowledge of accounting skills
- Submitted claims electronically, ensuring accuracy and timely processing.
- Contacted insurance companies to inquire about the status of pending claims.
- Managed insurance claims submissions and followed up on outstanding payments.
- Post and accurately distributes insurance payments to patient accounts
- Work the clinic accounts receivable in a timely and procient manner
- Immediately led and key in secondary insurance once primaryinsurance EOB is received
- Appropriately led Medicaid crossovers in a timely manner
- Displays the ability to pull copies of claims and attach EOBs in a timely manner
- Returns requested information to insurance companies in a timely manner
- Appropriately prints and mails follow-up
- Requests patient refunds with appropriate documentation
- Demonstrate the ability to communicate with patients concerning accounts (insurance rejections, other required information, etc.)
- Report monthly concerning problems with insurance and patient account balances
- If applicable, correct and follow up with patient information from health center (i.e. of insurance cards, date of birth, etc.)
- Resolved patient complaints regarding account balances, insurance coverage, and payment plans, improving patient experience.
- Effectively collects all data necessary for preparation of insurance financial reports
- Educated patients on insurance benefits and healthcare services, enhancing their understanding and satisfaction.
- Analyzed claims denials from third party payers and identified potential solutions for reimbursement.
- Reviewed EOBs statements submitted by insurance companies for accuracy against provider's charges.
- Compared statements against patient files.
- Resolved any issues arising from incorrect or incomplete documentation relating to a particular claim.
- Ensured compliance with company policies concerning the privacy of confidential health information.
- Initiated collection activities on delinquent accounts while adhering to HIPAA guidelines and regulations.
Medicare Customer Service Representative II
Maximus Federal Services
06.2023 - 06.2024
- Reviewed Part A overlap claims to ensure accurate processing and compliance
- Facilitated same-day transfers of patient records between departments
- Researched outpatient services for patients receiving inpatient treatment to support appropriate billing
- Assisted with Level 1 redetermination for appeals to facilitate timely resolution of claims
- Conducted research on appeal cases to support decisions
- Escalate suspended claims to Medicare Administrative Contractor
- Inquire job aids for complex calls
- Search for to discover ancillary claims
Medicare Customer Service Representative II
Maximus Federal Services
01.2023 - 06.2024
- Processed Medicare Advantage Plan disenrollment and opt-out requests during special election periods.
- Provided accurate information to effectively answer questions, troubleshoot issues, and resolve customer complaints.
- Handled escalated calls professionally by listening carefully to needs of each individual customer before offering appropriate solutions.
- Navigated multiple computer systems and applications to efficiently locate information for customer inquiries.
- Obtained and examined relevant information to assess validity of complaints and determine possible causes.
- Analyzed and collected customer information to prepare product or service reports.
- Developed and maintained positive relationships with customers by providing timely, accurate information and solutions to their inquiries or problems.
- Documented inquiries and complaints to ensure accurate and up-to-date records of customer interactions.
- Read from scripts to promote uniformity and consistency in communications.
Medicare Tier 1 DME Representative
Maximus Federal Services
06.2022 - 06.2024
- Determine if a claim was denied due to the need of a certificate of medical necessity.
- Review and explain how to file an appeal if there's a disagreement with the status of a claim.
- Received Tier 1 transfers to address claim detail visibility issues for suppliers.
- Ask probing questions to make sure I have the correct dates so that I can research the Medicare account correctly.
- Conducted three-way calls with beneficiaries and suppliers to ensure accurate understanding of claim details.
- Facilitated communication between beneficiaries and suppliers to resolve claim processing discrepancies.
- Escalated claim issues to DME MAC for resolution.
AB Claims Representative
Maximus Federal Services
04.2022 - 06.2024
- As a Medicare Claims CSR, the the front line for assisting beneficiaries with complex claim information.
- Reviewed action codes and modifier codes to ensure accurate processing.
- Resolved incorrect claims transfers from Tier 1 agents to enhance claim accuracy.
- Clarified denied claims information to beneficiaries, improving understanding of claim processes.
- Determined caller types for A/B claims to route inquiries effectively.
- Maintained a positive attitude during calls to enhance customer experience.
- Working with suppressed Medicare Summary Notices.
- Supplied various types of IRP items based on client needs.
- Assisted with maintenance, servicing, repairs, and replacements to ensure client satisfaction.
Tier 1 Customer Service Representative
Maximus Federal Services
09.2021 - 06.2024
- Assisted beneficiaries in correcting information using scripting and reference materials like HTKR.
- Managing a Great Compliance of 90% or higher.
- Explaining to beneficiaries how to file appeals correctly.
- Reading and Explaining Medicare Summary Notices.
- Guided beneficiaries in understanding detailed information about Medicare coverage.
- Facilitated enrollment of beneficiaries into Medicare Advantage plans and MAPDP.
- Explaining how supplement plans work.
- Explaining Medigap options.
- Giving information about Fraud and Supplemental Crossover and Medicare Secondary Payer to Beneficiaries.
- Using scripting to explain why a claim was denied.
- Escalating difficult calls.
- Transferred calls to Tier 2 agents for further assistance.
- Transferring calls to Claims CSRs if needed.
- Keeping a Professional Demeanor during difficult calls.
- Adhere to Privacy Act and Health Insurance Portability & Accountability Act (HIPAA) requirements as it relates to confidentiality of information released.
- Maintained confidentiality of PHI and PII according to regulations.
- Making sure that I am updated on training in Cloud, CCO Learning and My Learning.
- Making sure to use Microsoft Teams when getting assisted from Internal Support Group.
- Using the dashboard to take notes on every call.
- Reviewed scorecard weekly to review any areas of improvement to perform job duties.
- Transferring calls to Claims CSR's if needed.
- Using the dashboard to take notes on every call.
Sales Associate
Simply10
05.2021 - 08.2021
- Assisted customers in selecting outfits, shoes, and jewelry to enhance their shopping experience.
- Resolved customer complaints by employing positive language to ensure satisfaction.
- Performed cashier duties during busy periods.
- Promoted adherence to company policies and procedures to maintain operational standards.
- Restocking throughout the store.
- Making sure everything was organized throughout the store.
- Completed assigned tasks promptly.
- Report problems that occur and assist with the resolution.
Education
Associate of Arts - Physical Therapy
Jones Community College
Ellisville, MS05-2021
Associate of Arts - Physical Therapy Pre-Physical Therapy
Pearl River Community College
Hattiesburg, MS12-2020
Skills
- Customer support
- Call Center Operations
- Member account management
- Service recovery
- Complaint handling
- Issue resolution
- Relationship building
- Customer relations
- Customer needs assessments
- Microsoft Teams
- Membership renewals
- Process improvement
- Training facilitation
- Focus group moderation
- Data entry proficiency
- Payment processing
- Transaction processing
- Claims processing
- Document processing
- Quality assurance
- Negotiation communication
- Webex
- Member onboarding
- Microsoft Teams
- Microsoft Office Suite
- Microsoft Excel
- Word
- PowerPoint
- Outlook
- SharePoint
- Visio
- OneNote
- Data proficiency
- Data evaluation
- Database management
- Financial services knowledge
- Health services knowledge
- Analytical thinking
- Problem solving
- Critical Thinking
- Conflict resolution
- Escalation management
- Workflow optimization
- Inbound management
- Teamwork
- Organization
- Multitasking
- Work prioritization
- Adaptability
- Technology
- Time management
- Calm demeanor
- Empathy
- Active Listening
- Interpersonal skills
- Issue resolution
- Professional demeanor
- Reliability
- Patience
- Service recommendations
- Customer education
- Financial transactions
- Complaint tracking
- Dispute resolution
- Banking support
- Work prioritization
- Real-time adherence
- Cross-functional collaboration
- Project management
- Data evaluation
- Active listening
- Process transactions
- Reliability
- Professional demeanor
- Microsoft Office Suite
- Analytical thinking
- Inbound management
- Market awareness
- Cross-functional collaboration
- Customer retention strategies
- Project management
- Customer needs assessments
- Billing procedures
Languages
English, Advanced
Timeline
Member Service Advocate
Foundever
08.2025 - Current
Patient Account Representative/ Medical Receptionist
Southeast Mississippi Rural Health Initiative
06.2024 - 07.2025
Medicare Customer Service Representative II
Maximus Federal Services
06.2023 - 06.2024
Medicare Customer Service Representative II
Maximus Federal Services
01.2023 - 06.2024
Medicare Tier 1 DME Representative
Maximus Federal Services
06.2022 - 06.2024
AB Claims Representative
Maximus Federal Services
04.2022 - 06.2024
Tier 1 Customer Service Representative
Maximus Federal Services
09.2021 - 06.2024
Sales Associate
Simply10
05.2021 - 08.2021
Associate of Arts - Physical Therapy
Jones Community College
Associate of Arts - Physical Therapy Pre-Physical Therapy
Pearl River Community College