Allyn West
Abilene,TX
Summary
Encouraging manager and analytical problem-solver with talents for team building, leading and motivating, as well as excellent customer relations aptitude and relationship-building skills. Proficient in using independent decision-making skills and sound judgment to positively impact company success. Dedicated to applying training, monitoring and morale-building abilities to enhance employee engagement and boost performance.
Overview
21
21
years of professional experience
Work History
Customer Advocate Specialist (Blue Card Central)
HCSC Blue Cross Blue Shield
08.2022 - 09.2024
- Educated and mentored Customer Advocates, CAWs, and Technicians to enhance workflow efficiency and effectiveness.
- Maintained high customer retention rates by providing exceptional support.
- Assisted in developing training materials for new team members.
- Resolved complex issues to achieve successful outcomes.
- Supported team efforts to achieve and exceed customer service goals.
- Coordinated with other departments to ensure seamless service delivery.
- Developed strategies for handling challenging customer interactions.
- Trained new team members on company policies and procedures, ensuring consistent customer experiences.
- Served as an escalation point for unresolved complaints, working collaboratively with colleagues to find satisfactory resolutions.
- Facilitated Learning Lab sessions to enhance team skills, knowledge, and effectiveness, ensuring alignment with organizational goals.
- Coached team members on trending issues and new processes, developing customized training approaches to enhance performance and quality.
- Analyzed workflows to identify improvement opportunities, developing and implementing strategies to enhance efficiency and service quality.
- Supported team members in fielding Plan-to-Plan (P2P) calls, managing Host and Home inventory, and addressing escalated assist line inquiries.
- Managed general inquiries and medical records cases, providing timely and precise responses to team and customer needs.
- Collaborated with supervisors, upper management, and cross-functional teams to resolve escalated P2P inquiries, ensuring customer satisfaction.
- Partnered with IPBSs, Group Benefit Specialists, and management teams to resolve complex cases and ensure compliance with servicing requirements.
- Utilized advanced understanding of RTB across all 5 states, Dashboard, Procedure Flow, and Medical Policy to enhance team operations and effectively resolve issues.
- Utilized advanced systems such as Aerial, NICE, and e-Sales to address and process complex claims, and to handle VIP releases.
- Managed high-priority tasks, including Manual Calculations, Medicare Exhaust cases, VIP Releases, Overdrafts, Misquotes, Host Back Outs, and Reimbursement/Subrogation.
- Conducted thorough research and analysis to locate critical information and provide resourceful solutions for team members and customers.
- Collaborated with internal and external stakeholders to enhance communication skills and improve understanding of P2P servicing requirements.
- Acted as a resource for team members, providing clear guidance and ensuring accurate, consistent delivery of information.
Health Advocate Specialist
HCSC, Blue Cross Blue Shield
01.2020 - 08.2022
- Educated members on their insurance rights, individual policies, and benefits, empowering them to make informed decisions about their healthcare and coverage.
- Submitted appeals on behalf of members by conducting thorough research on claims and medical policies, and compiling necessary documentation to support their cases.
- Collaborated with provider offices to identify specific procedure codes, ensuring the delivery of precise and comprehensive benefit information to members.
- Partnered with in-house clinicians to connect members with appropriate resources and vendors, ensuring they received the support and services available to them.
- Analyzed claims data to provide members with a clear understanding of how their benefits were applied, resolving questions and enhancing their overall experience.
- Served as a Learning Coach, conducting mock calls with team members, evaluating their performance, and providing actionable feedback to enhance their skills.
- Facilitated Google Meet training sessions for new hire classes, instructing them on claim processing procedures and best practices to ensure success in their roles.
ERS Customer Advocate
HCSC, Blue Cross Blue Shield
11.2018 - 01.2020
- Enhanced customer satisfaction by promptly and effectively resolving inquiries and complaints, ensuring a positive member experience.
- Provided accurate medical benefit information to members, helping them understand their coverage and maximize their benefits.
- Assisted members in locating in-network providers, ensuring they could fully utilize their insurance benefits.
- Analyzed and adjusted medical claims to resolve issues, maintaining accuracy and fostering trust with members.
- Increased customer satisfaction through professional and empathetic handling of patient inquiries regarding billing concerns and insurance coverage.
- Interpreted complex Explanation of Benefits (EOB) forms, verifying accurate billing and guiding members to understand how their benefits were applied.
Server
Famous Dave’s
11.2010 - 10.2013
- : Time Management
- : Excellent Customer Service
- : Conflict Resolution
- : Processed payments
- : Handled and cataloged inventory
Lead Bartender / Server
Joe Allen’s
07.2008 - 11.2010
- : Created the schedule for the Staff
- : Worked directly with vendors
- : Conflict Resolution
- : Ordered new supplies and cataloged inventory
- : Facilitated on-site training for staff and new hires
- : In charge of making sure that bar area was compliant with TABC regulation : Facilitated on-site training for staff and new hires
Executive Assistant
North American Analytical Labs
03.2007 - 05.2009
- : Put together bids for Projects
- : Maintained Database
- : Entered Data from reports
- : Reviewed Client Paperwork
- : Update Appointment Calendar
- : Coordinated Project Schedules
- : Made Sure Sub Contractors had up to date Certification
- : Accounts Payable
Floor Supervisor
Teleperformance
08.2003 - 11.2006
- : Responsible for a team of20-25 Customer Advocates
- : Daily Feedback
- : Weekly Screening of the teams calls to provide feedback and coaching
- : Trained team de-escalating calls
- : Created Schedules
- : Handled discrepancy with my teams’ hours
- : Trained and Scheduled training for software updates
- : Was a part of the team that opened and launched the opening of a new call center
Education
High School -
Cooper High School
Abilene,TX01.2019
AAS - Nursing
Cisco College
Abilene, TX01.2014
Skills
- POWERPOINT
- MICROSOFT
- ABS
- MATRIX
- BLUE2
- EXCEL
- CMOD
- CLAIM ARCHIVAL TOOL
- MySQL
- Google Sheets
- Problem resolution
- Conflict management
- Communication skills
Timeline
Customer Advocate Specialist (Blue Card Central)
HCSC Blue Cross Blue Shield
08.2022 - 09.2024
Health Advocate Specialist
HCSC, Blue Cross Blue Shield
01.2020 - 08.2022
ERS Customer Advocate
HCSC, Blue Cross Blue Shield
11.2018 - 01.2020
Server
Famous Dave’s
11.2010 - 10.2013
Lead Bartender / Server
Joe Allen’s
07.2008 - 11.2010
Executive Assistant
North American Analytical Labs
03.2007 - 05.2009
Floor Supervisor
Teleperformance
08.2003 - 11.2006
High School -
Cooper High School
AAS - Nursing
Cisco College
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