Carmella Mobley
Girard,GA
Summary
Results-driven customer service and claims representative with 20 years of experience in resolving customer issues and managing claims. Proven ability to work effectively in both autonomous and team-based settings, with a strong track record of building lasting relationships with clients, colleagues, and stakeholders. Proficient in TPA systems. Skilled in conflict resolution, negotiation, and communication, with a passion for delivering exceptional customer service.
Overview
27
27
years of professional experience
Work History
Subject Matter Expert, Customer Service Advocate
Voya Financial
10.2022 - Current
- Deliver exceptional customer service through inbound and outbound calls, callbacks, chats, and email correspondence, striving for first-call resolution.
- Provide clear and concise information to customers regarding complaints and services, maintaining a professional demeanor.
- Accurately document call notes and research issues, utilizing relevant systems and resources.
- Resolve customer support issues through troubleshooting techniques and resource utilization, providing timely solutions.
- Educate customers on our services, ensuring they understand their options and benefits.
- Gather and analyze relevant data to effectively address customer complaints and inquiries.
- Conduct customer verifications to ensure accuracy and completion.
- Maintain HIPAA compliance at all times, adhering to established procedures and guidelines.
- Solve problems by leveraging online internal resources, ensuring efficient issue resolution.
- Monitor and meet monthly performance metrics for chats, emails, and calls, with regular quality control reviews.
Supervisor/ Caseworker
Building Brighter Futures
01.2017 - Current
- Performs job responsibilities with minimal supervision.
- Serves as job expert or organization resource in assigned areas.
- Collects and analyzes data related to performance indicators and resources.
- Conduct research, develops social programs, assesses, coordinates and develops awareness of existing services and ensures that duplication is avoided.
- Designs and publishes plans for assessing the needs of the programs and the implementation of the plans.
- Develops and delivers formal and informal training.
- Develops policies and procedures in accordance with laws and regulations related to primary programs.
- Develops social programs, social legislation, or proposals based on demographics, social and economic analysis and the evaluation of pilot projects.
- Identifies and assesses economic and social developments.
- Identifies, plans and implements the development and utilization of local resources.
- May serve as mentor to new supervisors and staff.
- Monitors compliance evaluates effectiveness and recommends/implements improvements to existing policies.
- Monitors the programmatic and financial activities.
- Provides direction and support for the ongoing operation of specialized programs.
- Provides technical assistance/training to internal and external service providers, developing policy interpretation, contractual services and/or evaluating quality and management.
- Counseling clients and helping them deal with personal and social problems.
- Developing and evaluating programs for assistance, prevention, and intervention.
- Investigating and taking protective measures in cases of child abuse or neglect.
- Working with patients to help them cope with everyday stresses or mental health struggles.
- Identifying people and communities in need.
- Assessing clients' needs, strengths, and support networks
- Helping clients adjust to life changes.
- Connecting with resources: Researching referring and advocating for community resources, such as food stamps, healthcare, or childcare.
- Monitoring clients: Following up with clients to ensure that their situations have improved.
- Maintaining records: Keeping case files and records.
Pharmacy Benefit Analyst
OptumRx
08.2015 - 01.2022
- Resolved complex claims issues for team members and internal customers through expert analysis and problem-solving.
- Prepared and transmitted claim batches to Medicaid, Medicare, and TPA payers, ensuring timely and accurate processing.
- Supported the implementation of process updates, provides training and mentoring, and ensures seamless system transitions.
- Evaluated claims to assess liability and render timely resolutions, ensuring fair and accurate outcomes.
- Interpreted guidelines, benefit plan documents, and certificates to ensure accurate application of benefits to each claim, maintaining compliance and accuracy.
- Provided expert claims support through thorough research, investigation, negotiation, and resolution of claims for health plans, commercial customers, and government entities.
- Analyzed data to identify trends and patterns, providing actionable insights through regular reports to inform business decisions.
- Reviewed and processed payer claims in a timely and accurate manner, ensuring prompt reimbursement and minimizing financial losses.
- Demonstrated expertise in understanding and applying plan concepts, including deductibles, coinsurance, copays, and out-of-pocket expenses.
Case Manager & Community Liaison
Community Outreach for Youth and Family Services
03.2005 - 12.2014
- Developed and maintained relationships with community partners to enhance services or social determinants of health
- Provided information and resources to clients on community services, benefits, and programs
SENIOR CUSTOMER CARE CONSULTANT
Knology
01.1998 - 01.2005
- Handled customer billing issues and service/trouble calls for all products
- Coordinated with other departments to resolve issues and complete services
- Followed up with customers to ensure satisfaction and problem resolution
- Resolved escalated customer service problems
- Handled outbound sales calls to prospective customers and present add-on and upgraded services to current customers
- Processed orders and coordinate with other departments to establish services
Education
Associate of Art -
Bachelor of Science - undefined
Master of - undefined
Bachelor of Science - Psychology
University of Phoenix
Tempe, AZAssociate of Arts - Psychology
University of Phoenix
Tempe, AZ06.1999
Skills
- Proven organizational and prioritization skills, with the ability to multitask and manage multiple projects simultaneously
- Exceptional written and oral communication skills, with the ability to effectively articulate complex ideas and concepts
- Proficient in Microsoft Office, including Word, Excel, and PowerPoint
- Strong customer service skills, with experience handling customer inquiries and claims
- Subject matter expert in medical and health terminology, with experience in coding and related procedures
- Detail-oriented and meticulous in all aspects of work, ensuring accuracy and quality in output
Timeline
Subject Matter Expert, Customer Service Advocate
Voya Financial
10.2022 - Current
Supervisor/ Caseworker
Building Brighter Futures
01.2017 - Current
Pharmacy Benefit Analyst
OptumRx
08.2015 - 01.2022
Case Manager & Community Liaison
Community Outreach for Youth and Family Services
03.2005 - 12.2014
SENIOR CUSTOMER CARE CONSULTANT
Knology
01.1998 - 01.2005
Bachelor of Science - undefined
Master of - undefined
Associate of Art -
Bachelor of Science - Psychology
University of Phoenix
Associate of Arts - Psychology
University of Phoenix