Debra Sanneh
Houston,TX
Summary
Resourceful Specialist with a strong background in customer service and claims resolution. Proficient in analyzing grievances and developing effective solutions to enhance client satisfaction. Committed to meeting compliance standards and optimizing operational success through detailed research and communication.
Overview
12
12
years of professional experience
Work History
APPEALS AND GRIEVANCE SPECIALIST
Molina Healthcare
Houston, Texas
09.2022 - Current
- Conducted comprehensive research to resolve appeals, disputes, grievances, and complaints from Molina members and providers, ensuring member satisfaction and adherence to protocols.
- Utilized support systems to analyze claims appeals and grievances and determine outcomes.
- Reviewed medical records, notes, and detailed bills; formulated conclusions based on protocols and guidelines.
- Ensured compliance with internal, state, and federal timelines for responses.
- Applied contract language to review covered services and benefits effectively.
- Communicated with members and providers through written and verbal correspondence.
- Prepared appeal summaries and documented findings, including trend analysis, to inform decision-making and identify areas for service improvement.
- Researched claims processing guidelines, provider contracts, fee schedules, and system configurations to identify payment errors.
INBOUND CUSTOMER SERVICE REPRESENTATIVE
APPLEONE/ANTHEM
Houston, Texas
04.2021 - 09.2022
- Greeted callers warmly, creating a welcoming atmosphere that encouraged positive customer interactions.
- Resolved complaints effectively, fostering customer loyalty and future transactions.
- Supported customers with COVID-19 vaccination scheduling and communications, ensuring timely access to vital information.
- Educated customers on product features and benefits to boost sales and satisfaction.
- Responded to inquiries about merchandise, pricing, and company updates, facilitating informed purchasing decisions.
- Made outgoing calls to follow up on vaccination-related questions.
- Utilized independent judgment to assess logistics of appointment timeslots and distances.
CUSTOMER SERVICE REPRESENTATIVE
Vincent Benjamin Staffing
02.2021 - 05.2021
- Provide great customer service and have empathy and kindness at all times.
- Delivered primary customer support to internal and external customers, ensuring timely resolution of inquiries.
- Provided tailored advice and assistance to customers, addressing special needs and preferences to improve satisfaction.
- Recommended products to customers while clearly explaining features and benefits to enhance their purchasing decisions.
- Receive inbound calls from individuals needing COVID Vaccine information.
- Supplied resources and information based on initial training.
GRIEVANCE APPEALS SPECIALIST
Cigna Healthspring
06.2014 - 07.2020
- Contacted insurance carriers to clarify policies and patient-specific benefits, ensuring compliance and effective claims processing.
- Determined payer appropriateness to protect organization and minimize risk exposure.
- Obtained documentation and evidence for resolution evaluation through outreach calls and emails, enhancing case accuracy.
- Verified client information by analyzing existing evidence on file.
- Entered all patient and insurance data into company computer system using [software].
Education
Bachelor of Science - Business Administration And Management
Wiley College
Marshall05-1990
Skills
- Customer account management
- Client relations specialist
- Customer service excellence
- Negotiation skills
- Data analysis
- Microsoft Office
- Software proficiency
- Problem solving
- Attention to detail
- Time management
Additional Information
Creative customer care professional dedicated to consistently surpassing service goals with unparalleled support for customer needs. Smoothly manages both incoming and outgoing calls and remote requests by applying strong organizational, research and time management skills. Solid history of success in fast-paced call centers. Collaborative leader with dedication to partnering with coworkers to promote engaged, empowering work culture. Documented strengths in building and maintaining relationships with diverse range of stakeholders in dynamic, fast-paced settings. Customer Service Representative bringing top-notch skills in oral and written communication, active listening and analytical problem-solving skills. Enhances customer experiences by employing service-oriented behaviors, understanding customer desires and providing customized solutions to build loyalty.
Timeline
APPEALS AND GRIEVANCE SPECIALIST
Molina Healthcare
09.2022 - Current
INBOUND CUSTOMER SERVICE REPRESENTATIVE
APPLEONE/ANTHEM
04.2021 - 09.2022
CUSTOMER SERVICE REPRESENTATIVE
Vincent Benjamin Staffing
02.2021 - 05.2021
GRIEVANCE APPEALS SPECIALIST
Cigna Healthspring
06.2014 - 07.2020
Bachelor of Science - Business Administration And Management
Wiley College