Carlos D. Howard
Woodbridge,VA.
Summary
Health Advisor experienced handling high volume of calls in fast-paced call center environments. Well-versed in answering questions, researching problems and resolving discrepancies. Detail-oriented and personable with exceptional work ethic and passion for service. Hardworking and passionate job seeker with strong organizational skills eager to secure an intermediate to mid level Human Resources Coordinator position. Ready to help team achieve company goals. Dedicate customer service professional with history of meeting company goals utilizing consistent and organized practices. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand.
Overview
13
13
years of professional experience
Work History
Senior Health Advocate
UnitedHealthcare
09.2019 - Current
- Process and pay medical and financial account claims
- Assist peers and supervisors with escalated issues
- Provide concierge services to members to assist with resolving issues with internal and external business vendors which includes inquiries about claims, billing discrepancies, plan benefits and other issues
- Simplify health care system guidance and drive engagement in programs across the continuum of care
- Research complex claims issues across multiple databases and work with support resources to resolve customer issues in addition to collaborating with other departments to resolve escalated issues
- Meet quality and customer satisfaction requirements as well as Maintain proficiency in all technical applications
- Take accountability and ownership of any follow-up work needed to resolve and close issues to include benefits, eligibility, and claims as needed
- Identify and resolve anticipated issues for members in order to prevent future calls
- Participates in and supports the development and implementation of special projects.
- Helped members navigate enrollment process and choose appropriate options.
- Handled more than 40 daily inbound calls from health plan customers.
- Provided information such as copay and premium details, pre-approval procedures and available products.
- Contacted clients in person, by phone or in writing to ascertain compliance with required or recommended actions.
- Delivered services according to established advocacy and case management protocols and maintained accurate, legible and current documentation.
- Facilitated and advocated for client access to services for health education, financial assistance, and community resources.
E & I Benefit Advocate
UnitedHealthcare
10.2018 - 09.2019
- Resolves customer inquiries and concerns with first call resolution; assist with the members needs regarding benefits, eligibility, claims, financial spending accounts and correspondence
- Answers customer’s questions to help guide and educate them through selecting the best benefit plan options, maximize the value of their health plan benefits by helping them understand and select quality care providers
- Interfaces with insurance carriers, physicians, hospitals and other healthcare providers
- Research complex claims issues across multiple databases and work with support resources to resolve customer issues in addition to collaborating with other departments to resolve escalated issues
- Assist members in navigating the company website, cell phone applications, and tools
- Intervene with care providers on behalf of member to assist with appointment scheduling or connections to internal specialist for assistance.
- Participated in continuous improvement by generating suggestions, engaging in problem-solving activities to support teamwork.
- Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
- Quickly learned new skills and applied them to daily tasks, improving efficiency and productivity.
- Performed duties in accordance with applicable standards, policies and regulatory guidelines to promote safe working environment.
Performance Monitor Trainer/Claims Supervisor
GEICO
01.2016 - 08.2018
- Learned insurance policy regulatory information
- Handling insurance claims filed by policyholders and third-party
- Assisted in gathering data and information for cases
- Certified and licensed to handle auto claim cases in several different states
- Responsible for determining level of loss for each case based on information and injuries
- Identified possible red flags when analyzing various claims and assigned to SIU as necessary
- Optimized case management with establishment of best practices.
- Cultivated productive relationships with stakeholders, facilitating claims lifecycle.
- Built talented teams of 12 claims administrators dedicated to timely and compliant resolutions.
- Monitored team performance, enforcing compliance with corporate claims processes and procedures.
- Handled claims consistent with client and corporate policies, procedures, best practices and regulations.
- Developed a training manual for the new hire training class
- Met with management to discuss weekly goals and strategies for new hires
- Collecting pertinent information by interviewing witnesses and going through police records
- Verifying coverage offered for vehicles and property under policies and deciding steps.
Tier 1 Technical Support Advisor
Kelly Services
06.2015 - 11.2015
- Provided technical support for Apple Customers with their purchased devices
- Consistently communicating effectively with both technical and nontechnical apple users
- Used problem-solving skills and patience in dealing with frustrated users
- Demonstrated strengths in rapidly diagnosing, troubleshooting and resolving client issues.
Auditor/Assistance Coordinator
Mapfre Corporation/Road America
10.2012 - 07.2014
- Assisted with Administrative Reports as directed by Management
- Recently promoted to Secondary Tow Department
- Assisted in the training of new hires
- Assisted Management with Special Reports and Audits on certain client accounts
- Auditor for the Secondary Tow Department
- Also assisted performing Team Lead functions and handled escalated calls from assistance coordinators
- Operated in supervisor role as directed by management
- Provided escalation support
Education
Bachelor of Arts - Healthcare Administration
University of Arizona
Chandler, AZ01.2023
Skills
- Exemplary Customer Service skills
- Proficient with MS OFFICE, Internet and Database
- Written and Verbal Communication skills
- Seasoned in Conflict Resolution
- Familiar with CPT and HCPC codes for claims billing
- HIPAA Guidelines
- Client Needs Assessment
- Strategic Planning
- Information Management
- Patient Care Activities
Accomplishments
Charter Member of the 100 Black Men Collegiate Chapter, Columbus State University (Columbus, Georgia)
Served as President of the Minority Student Union, Columbus State University (Columbus, Georgia)
Affiliations
Customer Service Representative who can maintain customer satisfaction while working within company policies. Adept at utilizing a computer database handling several ongoing cases simultaneously and seeing a claim file through to its completion. I specialize in offering quick and efficient solutions to the variety of cases that are presented each day. Maintains a high level of professionalism, patience and efficiency to minimize customer dissatisfaction and increase customer loyalty.
Timeline
Senior Health Advocate
UnitedHealthcare
09.2019 - Current
E & I Benefit Advocate
UnitedHealthcare
10.2018 - 09.2019
Performance Monitor Trainer/Claims Supervisor
GEICO
01.2016 - 08.2018
Tier 1 Technical Support Advisor
Kelly Services
06.2015 - 11.2015
Auditor/Assistance Coordinator
Mapfre Corporation/Road America
10.2012 - 07.2014
Bachelor of Arts - Healthcare Administration
University of Arizona