ANTOINETTE F. TALLEY

• Received inbound calls in a Call Center environment from providers, health plans and patients
• Made telephonic outreach to health plans, provider offices and patients
• Completed notifications telephonically as well as by generating letter notifications to inform of medical treatment determinations
• Utilized engagement strategies to build rapport
• Accurately documented information received from members, provider offices, and health plan clients into Evolent's online clinical system
• Performed clerical duties such as faxing, scanning, telephone, voice mail systems and
  computer-based programs such as Microsoft Office
• Managed approximately 30 incoming calls, emails and faxes per day from customers
• Supported UM functions by performing activities that required evaluation or
  interpretation of clinical information
• Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflict
• Developed strong product knowledge to provide informed recommendations based on individual customer needs
• Exceeded performance metrics consistently, earning recognition as a top performer within the team
• Performed other duties as assigned

Provided differentiated customer service by anticipating customer needs, demonstrated compassion and care in all interactions, and actively identifying and resolving potential service issues

• Focused on customer by giving warm and friendly greeting, maintained eye contact and offered help locating additional items, when needed
• Accurately performed cashier duties - handled cash, checks and credit card transactions with precision while following company policies and procedures
• Maintained sales floor by restocking shelves, checking in vendors, updating pricing information and completing inventory management tasks as directed by store manager
• Supported opening and closing store activities, when needed
• Provided customer support to all departments, including photo and beauty, ensuring departments were fully stocked and operational while remaining current with all updated services and tools
• Assisted pharmacy personnel when needed, including working regular shifts in pharmacy as part of opportunities for growth and career development
• Embraced and advocated for new CVS services and loyalty programs that supported purpose of helping people on their path to better health

• Responsible for drafting payment letters to borrowers on approximately 15th day of each month
• Completed transfer of MINs within Mortgage Electronic Registration System (MERS)
• Drafted and provided insurance mortgage change letter to insurance company of record
• Labeled and shipped hazard insurance policies received on sold loans to current servicer of record
• Responsible for drafting and mailing goodbye letters to borrowers within 3 days of loan being sold to investor per RESPA guidelines
• Responsible for Closing-Out Post Closing Milestone
• Processed monthly payments received via mail or via online portal
• Responsible for following up with borrowers about loan payments due
• Prepared loans for loan boarding to Sub Servicers which included data entry, mortgage clause updates and prepared Final Closing Packages
• A working knowledge of Microsoft Word, Excel and Outlook is essential for this job function
• Create SOPs for future employees
• Expected to maintain satisfactory attendance and report to work on time every day
• Occasional overtime and travel
• Additional task as assigned

• Sorted documents and folders received daily
• Entered all documents and folders into correct cell/folder
• Used handheld scanners to identify/read barcodes on folders to be filed
• Pulled folders upon request
• Straightened files, performed physical cell audits and cleaned up area
• Enforced loss prevention and shortage control procedures
• Maintained general organization of file system

• Generated sales by determining customer's needs
• Developed product knowledge by learning the merchandise features and benefits
• Opened new charge accounts while operating cash register
• Maintained floor standard including replenishment, appearance and cleanliness
• Understood all systems and procedures relating to sales and credit transactions
• Enforced loss prevention and shortage control procedures

• Updated patient demographics and corrected errors to assist billing department
• Worked through coding or billing issues by EOB's, ensuring accuracy in timely manner
• Completed all required monthly in-services and educational training as required
• Properly documented patient account of all steps taken to resolve balance
• Other duties as assigned

• Administered new enrollment application changes and terminations to member records
• Corresponded with members/groups regarding enrollment transactions within the specific SLA
• Processed electronic enrollment discrepancy reports and notified groups when electronic enrollment files were not received as scheduled
• Reviewed system error reports and made corrections as necessary
• Produced enrollment analysis reports using the software applications in preparation for senior leadership
• Notified members of physician changes and terminations

• Managed Provider demographic information changes (tax identification numbers, new addresses, (etc.) and resolved identifiable problems working with Credentialing Department to update information in the QNXT system
• Assisted Network Management/External Provider Relations team with network audits consistent with ongoing Network Management goals
• Researched and analyzed projects making corrections based off provider claims submissions
• Interfaced with a few departments within the organization and provided constructive feedback as well as executive data entry decisions
• Successfully completed special projects related to job as assigned by manager
• Held accountable for the quality of the provider data entered

• Reviewed processed enrollment and contracts for accuracy and completeness in accordance with established policies and procedures
• Prioritized projects and established time for critical deadlines
• Audited general business and service sector as assigned and communicated quality errors to Enrollment Technicians for correction to be completed in a set time frame
• Communicated errors with tact and diplomacy, using positive feedback as a training tool to improve quality results
• Documented all processing errors for follow-up from processors and recorded results in the quality assurance database for matrix reporting
• Performed quality audits with a goal of 99% accuracy based on MTM (Member Touchpoint Measures) quality program administered by Carefirst Blue Cross Blue Shield of Maryland
• Adhered to transmission timeframes to ensure completion of quality assurance review prior to transmission of data to carrier
• Kept abreast of current trends and regulatory issues surrounding carriers' plan design and administration
• Handled a 95% increase in workload without need for additional staff

• Generated inbound/outbound calls to assist consumers with obtaining affordable health care
• Registered/processed applications via HIPPAsuite and Health Insurance Exchange (HIX) software
• Completed 834 Enrollments and manual calculations as required
• Sold and assisted consumers with choosing Health Insurance Plans
• Provided Tier 2 second level support, to technical help desk by creating new user accounts, resetting passwords and unlocking accounts
• Ensured proper recording, documentation and closure in compliance with federal and state regulations

• Utilized consultative skills to assist client in purchasing affordable health care, assessing client's needs and appropriate eligibility by determining most cost efficient, comprehensive health care coverage
• Effectively communicated cost and benefits of Medicare insurance plans via telephone
• Interpreted and applied varying guidelines across multiple insurance carriers to applicant-specific health scenarios
• Complied with company's ethical policies and standards
• Worked effectively as team player across company's departments by maintaining efficient and professional work environment
• Handled calls using third party interpreting services
• Exceeded mandatory performance targets including quality, competencies and effectiveness of loss resolution
• Referred clients to community resources that provided no-cost or low-cost financial aid, health care services, and work-skills training