CLAIRINE FILS-AIME
Miami,FL
Summary
Professional with strong background in customer interactions and service solutions. Highly skilled in conflict resolution, communication, and problem-solving, ensuring customer satisfaction and loyalty. Effective team collaborator, adaptable to changing needs, and consistently focused on achieving results through efficient and empathetic service. Known for reliability and proactive approach to meeting customer and organizational goals.
Overview
11
11
years of professional experience
Work History
Government Relations
Change Healthcare/Optum
09.2019 - 08.2024
- Monitor changes in regulations and guidelines to ensure compliance with state and federal requirements
- Adapted quickly to policy changes or updates in regulations by revising application review procedures accordingly.
- Managed caseloads effectively through regular follow-ups and prompt communication with clients, ensuring their needs were met throughout the process.
- Organized relevant documentation for audits both internally and externally ensuring compliance within established guidelines.
- Maintained up-to-date knowledge of federal, state, and local regulations to ensure accurate eligibility determination.
Case Manager/ Eligibility Specialist
Change Healthcare
06.2015 - 09.2019
- Evaluated client applications for program eligibility and provided recommendations
- Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
- Educated clients on available programs, benefits, and services, empowering them to make informed decisions about their care needs.
- Trained new case managers, raising team's overall competency and service delivery standards.
- Interviewed applicants and explained scope of different available benefits.
Eligibility Counselor/ Recertification Specialist
Change Healthcare
10.2013 - 06.2015
- Efficiently managed caseloads, ensuring all clients received prompt attention and assistance throughout the application process.
- Achieved high levels of customer satisfaction through attentive listening skills and personalized guidance regarding benefits eligibility.
- Managed a high volume of incoming inquiries from patients, providing clear explanations about the recertification process and assisting them through every step.
- Followed guidelines when reviewing applicant data to determine eligibility for economic assistance.
- Assisted patients with complex cases, resolving issues and ensuring continued access to necessary care.
Education
Pharmacy Technician Diploma - Pharmacy Tech.
Keiser Career College
Miami, FL07-2009
High School Diploma -
North Miami Senior High School
North Miami, FL06.2008
Skills
- Excellent presentation and communication skills
- Strong time-management skills
- Deadline oriented
- Ability to work under minimal supervision
- Confidentiality familiar on HIPPA laws
- Customer Relations
- Answering customer questions
- Problem-solving skills
- Record preparation
- Resolving customer issues
- Multitasking Abilities
- Reliability
Languages
Creole
Professional Working
Timeline
Government Relations
Change Healthcare/Optum
09.2019 - 08.2024
Case Manager/ Eligibility Specialist
Change Healthcare
06.2015 - 09.2019
Eligibility Counselor/ Recertification Specialist
Change Healthcare
10.2013 - 06.2015
High School Diploma -
North Miami Senior High School
Pharmacy Technician Diploma - Pharmacy Tech.
Keiser Career College
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