Charise Simon
Boynton Beach,FL
Summary
Seasoned, dedicated and knowledgeable customer service professional with extensive experience of 9+ years in the health insurance industry. Solid team player with outgoing, positive demeanor and proven skills in establishing rapport with clients. Motivated to maintain customer satisfaction and contribute to company success. Specialize in quality in order to process optimization. Articulate, energetic and results-oriented with exemplary passion for developing relationships and cultivating partnerships.
Overview
10
10
years of professional experience
Work History
Customer Service Associate II
UST Health Proof/Clover Health
10.2023 - Current
- Maintained a high level of product knowledge, providing accurate information to customers about plan benefits and coverage.
- Educated customers about billing, payment processing and support policies and procedures. e.g Late Enrollment Penalties and premium charges
- Met customer call guidelines for service levels, handle time and productivity and quality call average of 97%
- Maintained accurate records of customer interactions, ensuring proper documentation within company''s database.
- Assisted in mentorship with new hires, sharing best practices in customer service protocols specific to healthcare industry.
- Promoted positive work environment through active participation in team meetings and chats.
- Ensured compliance with HIPAA regulations when handling sensitive patient information, protecting client privacy at all times.
- Managed difficult conversations with compassion and professionalism, helping deescalate tense situations while maintaining focus on finding resolutions.
- Reviewed claims and provided details on processing of services rendered
- Responding to inquiries and answering concerns about balances, transactions and activities on our Live Healthy and OTC programs
- Addressing customer concerns, demonstrating empathy, and resolving problems swiftly.
- Utilized internal software and tools to meet customer needs. e.g. Advantasure, Healthedge (HRP), SDS, Salesforce etc
Customer Service Representative
United Health Group/Optum Services
08.2015 - 08.2023
- Educated customers and providers about claims, billing and explained payment process to support policies and procedures.
- Handled an average of 80+ incoming calls on detailed questions and issues with a resolution
- Facilitated training classes for new hires and peers assigned to our Health and Wellness queue.
- Trained for an Over-the Counter program to place and correct orders
- Optimized and maintained business metrics in peak periods.
- Processed mail to maintain and update customer records.
- Assisted members with Social Determinants of Health finding resources in their community
- Supported the Underwriting department, in an investigative role, completing interviews on medical conditions or diagnosis for underwriters to make informed decisions on applications.
- Medical terminology knowledge. Followed all rules and guidelines of HIPAA
Certified Nursing Assistant
Independent Contractor - Self Employed
10.2018 - 04.2023
- Help patients effectively with activities of daily living
- Transport clients to doctors appointments and other errands
- Assisted those with limited mobility.
- Keeping spaces fresh and clean for patient health and satisfaction.
- Examined patients to detect symptoms that required medical attention.
- Provided care to patients throughout lifespan with consideration of aging processes, human development stages and culture.
Customer Service Representative II
Healthsource RI/Optum Services
10.2014 - 08.2015
- Educated customer about the Affordable Care Act and Medicaid
- Responded to inquiries assisted with product selection.
- Introducing the program, plan options available and assisted customers with making informed decisions for their household when applying and accessing health insurance coverage online.
- Promoted superior experience by addressing customer concerns, demonstrating empathy, and resolving coverage issues swiftly.
- Assisted customers by completing applications on their behalf
- Navigated website use and any troubleshooting issues.
- Collaborated with Trainers transitioning new hires to the work floor
- One on one peer guidance and Subject Matter Expert support.
- Compiled data on website issues and identified troubleshoot options.
- Liaised and provided data to State and City Officers from the Department of Human Services to improve system navigation, along with software updates.
- Followed all HIPAA rules and guidelines
Education
High School Diploma -
Corpus Christi College
Trinidad And TobagoPatient Care Technician/
911 Programs
Warwick, RISkills
- Call Volume and Quality Metrics
- Product and service knowledge
- Assertiveness
- Issue and Complaint Resolution
- Investigate Claims
- Teamwork and Collaboration
- De-Escalation Techniques
- Customer Support
- HIPAA Compliance
Timeline
Customer Service Associate II
UST Health Proof/Clover Health
10.2023 - Current
Certified Nursing Assistant
Independent Contractor - Self Employed
10.2018 - 04.2023
Customer Service Representative
United Health Group/Optum Services
08.2015 - 08.2023
Customer Service Representative II
Healthsource RI/Optum Services
10.2014 - 08.2015
High School Diploma -
Corpus Christi College
Patient Care Technician/
911 Programs
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