A'Briana Saunders
Winston-Salem
Summary
Customer Service Representative with 5+ years of experience specializing in managing multi-channel interactions and building strong client relationships. Proven ability to quickly master new systems, resolve discrepancies, and ensure accurate data entry. Detail-oriented and results-driven, with a strong focus on providing exceptional service and maintaining compliance with regulations. Seeking to leverage leadership, problem-solving skills, and industry knowledge to contribute to team performance and drive overall organizational success.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Expert Medical Services Representative
Blue Cross & Blue Shield of North Carolina
10.2019 - 11.2024
- Assisted Medicare and Medicaid members and providers with benefit coverage, eligibility verification, and claims inquiries.
- Processed and explained claims, denials, appeals, and grievances in compliance with CMS and state Medicaid guidelines.
- Handled provider requests for billing, coding clarification, and authorization requirements.
- Resolved member concerns regarding premiums, Explanation of Benefits (EOBs), co-pays, and cost-sharing.
- Completed and tracked medical and pharmacy prior authorizations for providers.
- Prepared and sent formal correspondence to members and providers regarding coverage decisions and appeal outcomes.
- Educated members on Medicare Advantage, Part D, and Medicaid managed care benefits.
- Ensured compliance with HIPAA, CMS, and Medicaid regulations during all interactions.
- Documented call details and actions accurately in CRM and claims systems
- Consistently met call quality, compliance, and productivity standards.
Prior Authorization Specialist - Phone & Chat Representative
MedQuest / Novant Health
01.2019 - 01.2021
- Facilitated prior authorizations for imaging and medical procedures by gathering clinical documentation.
- Supported providers and patients via phone and live chat, ensuring timely approvals.
- Entered, tracked, and monitored requests through EMR and payer portals.
- Ensured compliance with payer requirements to prevent delays in patient care.
Senior Customer Service Representative
Levelor Kirsch / Newell Brands
08.2017 - 09.2019
- Processed B2B orders for custom window blinds and shades using SAP, including order entry, updates, and tracking.
- Actively coordinated with shipping, stock, and receiving teams to ensure accurate and timely order fulfillment.
- Managed shipping changes, returns, and replacements to meet customer expectations.
- Provided technical and order support to retailers and distributors.
- Resolved warranty claims, returns, and product discrepancies.
- Handled escalated customer and provider issues, ensuring timely resolution and satisfaction.
Merchandise Lead
Kmart
06.2015 - 06.2017
- Oversaw daily merchandise operations, including stocking, pricing, and inventory management.
- Supervised and trained team members to maintain compliance with company policies.
- Delivered excellent customer service, handling returns and product inquiries.
Education
Associate Degree -
Forsyth Technical Community College
Winston-Salem, NC01.2027
High School Diploma -
Walkertown High School
Walkertown, NC01.2017
Skills
- Prior Authorizations, Claims Processing, Appeals & Grievances
- Medicare, Medicaid, and Insurance Plan Knowledge
- Member & Provider Support, Customer Service, Escalation Resolution
- Order Processing, SAP, Shipping & Inventory Coordination
- Data Entry, Documentation, and Workflow Accuracy
- CRM & Healthcare Systems: Facets, Epic, Rx Prime, EMR, Amysis, Salesforce, Zendesk
- Microsoft Office Suite, Teams, Zoom Collaboration
- Training, Mentorship, and Team Support
Key Skills
Prior Authorizations, Claims Processing, Appeals & Denials, HIPAA Compliance, Call Center, Chat & Email Support, Escalation Handling, Client Relationship Management, SAP, Facets, Epic, Rx Prime, EMR, Amysis, Salesforce, Zendesk, Microsoft Office, Teams, Zoom, Data Entry & Accuracy, Documentation, Workflow Optimization, Training & Mentorship
Affiliations
- Dean’s List, Forsyth Technical Community College – Recognized for academic excellence, maintaining a 4.0 GPA
- Employee Recognition Awards, Blue Cross & Blue Shield of NC – For exceptional customer service and compliance adherence
- Volunteer Community Outreach, Local Health & Wellness Initiatives – Assisted with public health education and insurance guidance
Accomplishments
- Consistently met or exceeded productivity and accuracy goals in handling prior authorizations and claims at Blue Cross & Blue Shield of NC.
- Successfully resolved complex escalations for members and providers, improving customer satisfaction scores.
- Trained and mentored new hires, enhancing team efficiency and knowledge retention in both healthcare and B2B environments.
- Improved order processing workflows at Levelor Kirsch, reducing shipping errors and speeding up fulfillment.
- Recognized with employee awards for outstanding customer service, compliance adherence, and problem-solving.
- Maintained a 4.0 GPA while balancing work and college studies.
- Assisted in streamlining communication between shipping, stock, and receiving teams to optimize order fulfillment.
- Managed high-volume member and provider inquiries across phone, email, and chat while maintaining HIPAA compliance.
Certification
- microsoft office certified
- high school diploma
References
References available upon request.
Timeline
Expert Medical Services Representative
Blue Cross & Blue Shield of North Carolina
10.2019 - 11.2024
Prior Authorization Specialist - Phone & Chat Representative
MedQuest / Novant Health
01.2019 - 01.2021
Senior Customer Service Representative
Levelor Kirsch / Newell Brands
08.2017 - 09.2019
Merchandise Lead
Kmart
06.2015 - 06.2017
Associate Degree -
Forsyth Technical Community College
High School Diploma -
Walkertown High School
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