Ann Kohel
Green Bay,WI
Summary
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
12
12
years of professional experience
Work History
Grievances & Appeals Representative 2
Humana
07.2022 - Current
- Analyze documents/case types to determine if information is missing to process member and/or provider request for appeal or grievance
- Acknowledge and create cases within Medicaid state guidelines, per state, to meet compliance and limit fines within my control
- Set up grievances and/or appeals cases based on information provided from calls, mail, or faxes
- Work independently and research new regulations for all new states
- Continuously looking for process improvements to be added to daily process flow for clarification or missing information
- Actively communicate with leadership and other associates during case research through email, chat, MedHok and PaHub
- Train new associates on Florida Medicaid Complaints process
- Run daily reports to monitor and confirm all cases due are completed by end of the day
- Effectively meet daily production and quality scores
- Received STAR award for staying late several days to save compliance by completed cases due same day and training others to help with influx of work to reduce possible fines.
Complaints Representative
Humana
10.2020 - 07.2022
- Analyze member complaints and respond to member by either verbal or written contact to ensure timely resolution in compliance with CMS requirements
- Utilize other contact center complaint handling units to assist in complaint resolution
- Make decisions regarding work approach/priorities based off policy
- Work within the MedHOK program for specific complaints for Grievances and Appeals
- Successfully work Good Cause Reinstatement report on a daily basis
- Assist with all Medicare tanks and ADA cases to be completed in a timely matter
- Lead spokesperson for Customer Service Advocate Program
- Analyze report of data to locate trends on a weekly basis
- Provide resolution and documents for customer service to use to help with sending complaints the correct way
- Listen to calls to locate areas of opportunity when documenting complaints before being transferred
- Send daily emails to customer service associates and leadership with positive/opportunity feedback
- Attended weekly meetings to go over all data with customer service management team
- Looked for ways to improve the members over all experience
- Effectively met daily production and quality scores.
Inbound Contact Representative
Humana
09.2019 - 10.2020
- Take and document inbound phone calls to address customer needs regarding pharmacy, web, benefits, claims, billing and demographic
- Resolve member concerns, questions, complaints, and educating members
- Record details of all interactions made, comments or complaints and billing transactions
- Bailout work specific project with Oral Grievance Oversight team to handle member complaints directly with member to ensure timely resolution in compliance with CMS requirements
- Part of Advanced Resolution and Concierge team to handle member escalated calls
- Exercise empathy and clear communication when speaking with members while practicing active listening
- Take special calls for all Honors, LEP/Creditable Coverage and IPA policies
- Worked special outbound call project for transportation benefits
- Received REACH all quarters for outstanding metrics.
- Adhered to company policies and scripts to consistently achieve call-time and quality standards
Key Manager/Local Store Marketer
Texas Roadhouse
07.2017 - 09.2019
- Assist Service and Kitchen managers on floor with table visits, comps, voids, over all guest satisfaction and continuity of the restaurant
- Managing twenty to twenty-five employees at a time
- Administrative duties such as tip share, payroll, ordering, weekly sales spreadsheets, inventory and invoices
- Building sales at local level by building relationships inside the restaurant and community
- Develop and execute marketing plans each quarter
- Promote all corporate programs and promotions
- Evaluate return-on-investment and profit-loss projections
- Efficiently and effectively, schedule 120 employees on four different weekly schedules
- Manage labor inefficiencies and food/alcohol waste to increase profitability of operations
- Train employees on facility procedures, safety codes, proper recipes and plating techniques
- Maintain continuous contact with kitchen staff, management and serving staff.
- Shadowed senior personnel on complex marketing pursuits to build skills set
- Updated customer database and generated lists and counts for direct marketing projects
Customer Service Representative
Schneider National
10.2016 - 12.2017
- Used varies types of communications to present quality orientated image where every customer is treated in consistent, courteous and efficient manner
- Develop and maintain strong customer relationships
- Anticipate and identify problems and proactively work to solve them for customer
- Engage and execute customer specific projects
- Meet or exceed total service needs of customers, along with taking steps to alleviate issues and improve service efficiency.
- Actively listened to customers, handled concerns quickly and escalated major issues to supervisor
- Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns
Advanced Service Representative
Thrivent Financial
03.2014 - 10.2016
- Respond to member inquires via standard or free form written communication
- Review daily workflow and phone coverage to coordinate any changes needed for team of 15
- Create Excel spreadsheets for allocation of employees
- Plan and coordinate multiple team building opportunities and create Team Moral board to foster positive attitudes and team work
- Member of Funshine Team which coordinates different activities for group of 75 people
- GLEE Team member which coordinates different volunteer activities and appreciation events for group of 300
- Procure goods utilizing purchasing card, reconcile purchases using corporate guidelines
- Receive HEART Awards for demonstrating ability to act like a guide
- Request computer security access to on board employees for different systems
- Provide organization to team LiveLink documents and folders.
- Planned schedules and workflows based on expected customer demands
- Responded to customer requests, offering excellent support and tailored recommendations to address needs
Customer Service Representative
Schneider National
11.2011 - 03.2014
- Used varies types of communications to present quality orientated image where every customer is treated in consistent, courteous and efficient manner
- Develop and maintain strong customer relationships
- Anticipate and identify problems and proactively work to solve them for customer
- Engage and execute customer specific projects
- Meet or exceed total service needs of customers, along with taking steps to alleviate issues and improve service efficiency
- Plan team different activities for 10 to 75 participants
- Create Team Moral board to foster positive attitudes and team work
- Customer Service Representative of the Year 2013 and Positive Team Member Award 2013.
- Handled customer inquiries and suggestions courteously and professionally
- Answered customer telephone calls promptly to avoid on-hold wait times
Education
Bachelor's Degree - Business Management
Concordia University of Wisconsin
Mequon, WI05.2013
Skills
- Grievance Resolution
- Administrative Support
- Customer Satisfaction
- Creative Solutions
- Active Listening
- Staff Training
- Microsoft Outlook
- Time Management
- Marketing and Advertising
- Money Handling
- Best Practices and Standards
- Research
Timeline
Grievances & Appeals Representative 2
Humana
07.2022 - Current
Complaints Representative
Humana
10.2020 - 07.2022
Inbound Contact Representative
Humana
09.2019 - 10.2020
Key Manager/Local Store Marketer
Texas Roadhouse
07.2017 - 09.2019
Customer Service Representative
Schneider National
10.2016 - 12.2017
Advanced Service Representative
Thrivent Financial
03.2014 - 10.2016
Customer Service Representative
Schneider National
11.2011 - 03.2014
Bachelor's Degree - Business Management
Concordia University of Wisconsin