Delora Brown
Customer Service represenative
Cullman,AL
Summary
Customer Service and Healthcare Enrollment Specialist with 30+ years of experience supporting Medicare, insurance, and benefits programs. Proven ability to manage high-volume inbound calls, resolve complex member inquiries, and ensure accurate enrollment and claims processing. Strong background in compliance, data accuracy, and client satisfaction, with experience training new staff and improving service workflows. Recognized for professionalism, attention to detail, and the ability to build trust with diverse populations.
Overview
34
34
years of professional experience
1
1
Certification
Work History
Enrollment Specialist
Humana Inc
Louisville, KY
09.2025 - 12.2025
- Guided members through Medicare and plan enrollment, explaining benefits, eligibility, and coverage options
- Verified applicant data, processed enrollments, and ensured accuracy and compliance with company policies
- Managed high-volume inquiries across phone and email while maintaining high satisfaction scores
- Tracked enrollment progress using internal systems and met strict productivity and quality benchmarks
- Collaborated with internal departments to resolve eligibility and documentation issues
Customer Services / Enrollment Specialist
F.H Cann & Associates
Exeter, NH
11.2024 - 01.2025
- Processed enrollments and documentation with a strong focus on accuracy and turnaround time
- Resolved customer concerns and answered benefit questions in a fast-paced call center
- Maintained detailed CRM documentation for all interactions and follow-ups
- Assisted in training new hires on service procedures and compliance standards
Claims Examiner
Health Plan Services
Tampa, FL
01.2024 - 08.2024
- Review submitted claims, supporting documentation, and policy contracts.
- Verify coverage eligibility under the policy provisions.
- Analyze medical records, repair estimates, police reports, or invoices (depending on claim type).
- Determine payable amounts based on policy limits, deductibles, and exclusions.
- Request additional documentation when needed.
- Contact claimants, providers, employers, or repair facilities for clarification.
- Identify inconsistencies, potential fraud, or billing errors.
- Ensure claims meet regulatory and company compliance standards.
- Decision Making
- Approve, deny, or partially approve claims.
- Provide written explanations for claim decisions.
- Apply state and federal insurance regulations appropriately.
- Documentation & Data Entry
- Maintain detailed claim notes in claims management systems.
- Update claim status accurately and timely.
- Meet productivity and accuracy benchmarks.
- Customer Communication
- Explain coverage decisions clearly to policyholders.
- Respond to appeals or disputes.
- Coordinate with adjusters, underwriters, or legal teams when necessary
Enrollment Specialist
Wipro Limited
Tampa, FL
10.2023 - 12.2023
- Processed membership enrollments, terminations, and ID card issuance
- Resolved discrepancies to ensure accurate member records
- Supported administrative operations to improve team productivity and service delivery Assisted clients with online applications for government healthcare programs
- Provided step-by-step support via phone, email, and web navigation
- Maintained compliance with federal privacy regulations and SOPs
Customer Care Representative (CCR)
Maximus Federal
Riverview, FL
01.2021 - 12.2022
- Responded to client inquiries via telephone with scripted responses, ensuring courteous and professional communication.
- Adhered to company protocols and privacy regulations, including timely submission of timesheets and compliance with standard operating procedures.
- Assisted clients in navigating online applications by providing guidance through telephone, email, and web browser support
- Dual trained in Medicare, Medicaid and Marketplace (Obama Care) for DME and Claims
- Answers calls and emails in timely manner, meeting performance goals
- Handles standard call types: tank requests, ETA inquiries, pick-up requests, location assistance, order status, pricing inquiries
- Documents call information per standard operating procedures
- Answers questions about products, services, retail stores, and general service information
- Verifies insurance carriers in database system
- Resolves customer complaints with problem-solving approach
- Maintains working knowledge of current products and services
- Adheres to HIPAA guidelines and maintains patient confidentiality.
Member Service Representative/Ccr1
Freedom Health Care / Anthem Inc
Tampa, FL
01.2018 - 01.2021
- Resolved customer inquiries concerning Medicare Advantage plans by employing clear communication to ensure effective issue resolution.
- Processed support tickets with detailed information on claims and eligibility, demonstrating strong problem-solving abilities.
- Maintained a professional demeanor and delivered attentive customer service in a high-pressure call center environment.
- Responded to Medicare Advantage inquiries related to eligibility, claims, and benefits
- Documented cases and processed service requests in CRM systems
- Maintained high call quality and customer satisfaction in a high-volume environment
Customer Service Clerk
General Dynamics Info Tech
Riverview, FL
01.2014 - 12.2017
- Key Responsibilities
- Process medical, dental, vision, and prescription drug claims accurately and timely
- Collaborate with various stakeholders to obtain for claim processing
- Claim appeals, disputes, and audits as needed
- LUMINX Processing
- Claims processing software
- Knowledge of claims processing procedures and requirement
- Processed medical, dental, vision, and pharmacy claims
- Assisted with appeals, audits, and claims corrections
- Utilized LUMINX and other claims systems to ensure accuracy and compliance
Customer Service Manager (CSM)
Mosica Vista
Tampa, FL
01.2013 - 01.2014
- Supervised a team of 7-10 employees, overseeing hiring, performance evaluations, and dismissals to maintain a high-performance work culture.
- Led regular department meetings to recognize team achievements and conducted training sessions to enhance efficiency and teamwork.
- Supervised and trained a team of 7–10 employees
- Conducted performance reviews and improved team productivity
- Led staff meetings and implemented customer service improvements
Construction Helper
Full Of Hope Cleaning Service
Tampa, FL
01.2010 - 01.2013
- Maintained cleanliness in commercial settings, enhancing customer experiences by ensuring well-kept rooms and halls.
- Assisted in room setups by reconfiguring furniture, hanging drapes, and placing carpets for events and routine operations, providing customized support to meet individual client needs.
Captain
Catering by the Family
Tampa, FL
01.2005 - 12.2009
- Pre-Event Planning & Preparation
- Review Banquet Event Orders (BEOs), contracts, and floor plans.
- Conduct pre-shift meetings to review menu, service style, VIPs, timing, and assignments.
- Inspect event space for proper setup (tables, linens, centerpieces, staging, AV needs).
- Coordinate with kitchen, bar, and event management teams on service timing.
- Staff Supervision & Leadership
- Assign sections and responsibilities to servers, bartenders, and support staff.
- Monitor staff performance and enforce service standards.
- Provide real-time coaching during service.
- Ensure uniform, grooming, and professionalism standards are maintained.
- Event Execution & Service Oversight
- Oversee plated, buffet, reception, or family-style service.
- Ensure food presentation, portion control, and timing meet specifications.
- Maintain compliance with food safety and sanitation regulations.
- Monitor bar operations and ensure responsible alcohol service.
- Client & Guest Relations
- Serve as primary on-site contact for event host or client representative.
- Address guest concerns or service issues promptly and professionally.
- Ensure special requests and VIP accommodations are executed accurately.
- Post-Event Operations
- Supervise breakdown and inventory of equipment and rentals.
- Ensure venue is restored to original condition.
- Report damages, incidents, or service notes to management.
- Provide feedback for continuous operational improvement.
Customer Service Rep Supervisor
Vision Care Inc
Tampa, FL
01.2000 - 12.2003
- Managed customer inquiries and processed an average of 200 calls daily, ensuring clear communication of vision insurance benefits and services.1. Team Leadership & Performance Management
- Supervise, coach, and develop Customer Service Representatives (CSRs).
- Monitor KPIs including Average Handle Time (AHT), Service Level, Abandonment Rate, Quality Scores, and First Call Resolution (FCR).
- Conduct performance evaluations and corrective action when necessary.
- Facilitate team meetings and ongoing training sessions.
- Medicare Vision Benefit Oversight
- Ensure accurate handling of Medicare Advantage vision inquiries including:
- Eligibility verification
- Coverage explanations (exams, lenses, frames, allowances)
- Claims status and appeals
- Provider network inquiries
- Oversee escalated member complaints and complex benefit cases.
- Ensure adherence to CMS guidelines and Medicare marketing regulations.Compliance & Regulatory Standards
- Maintain HIPAA compliance and safeguard Protected Health Information (PHI).
- Ensure team adherence to CMS regulations and internal audit standards.
- Support internal and external audits.
- Implement corrective action plans based on QA findings.
- Quality Assurance & Training
- Monitor recorded calls for accuracy and compliance.
- Develop training materials related to Medicare vision plan updates.
- Ensure representatives remain current on annual Medicare changes (ANOC, EOC updates).
- Collaborate with Compliance and Operations teams.
- Operational Management
- Manage scheduling to maintain service level agreements (SLAs).z
- Oversee workforce management coordination.
- Analyze call volume trends and forecast staffing needs.
- Partner with claims and provider relations departments to resolve systemic issues
Benefits Specialist
Compbenefits
Tampa, FL
01.1998 - 01.2000
- Primary Responsibilities
- Benefits Administration
- Manage enrollment, changes, and terminations in benefit plans.
- Administer medical, dental, vision, life insurance, disability, and retirement plans (e.g., 401(k)).
- Coordinate open enrollment processes.
- Ensure accurate payroll deductions related to benefits.
- Employee Support
- Explain benefit options, coverage details, and eligibility requirements.
- Assist employees with claims issues or billing discrepancies.
- Provide guidance on leave policies (FMLA, short-term disability, etc.).
- Respond to employee inquiries via phone, email, or in person.
- Compliance & Regulatory Oversight
- Ensure compliance with federal and state regulations such as:
- ERISA
- COBRA
- FMLA
- ACA
- Maintain confidentiality of employee health and personal data (HIPAA compliance).
- Prepare required compliance notices and documentation.
- Vendor & Carrier Coordination
- Act as liaison between the organization and insurance carriers.
- Resolve enrollment discrepancies or claim issues with providers.
- Review benefit invoices for accuracy.
- Data Management & Reporting
- Maintain accurate records in HRIS systems.
- Generate reports related to enrollment, utilization, and costs.
- Audit benefits data for accuracy
Housekeeping Supervisor
Hampton Inn & Suites
Tampa, FL
01.1995 - 12.1997
- Assign daily room quotas and section assignments based on occupancy forecasts.
- Inspect guest rooms (arrival, stayover, and checkout) to ensure adherence to 4-star cleanliness and presentation standards.
- Coordinate with Front Office for room status updates (vacant/dirty, out-of-order, rush rooms, VIP arrivals).
- Monitor turnaround times to meet check-in service level targets.
- Quality Assurance & Standards
- Conduct detailed inspections covering linen quality, amenity placement, odor control, and maintenance reporting.
- Ensure compliance with brand SOPs and luxury presentation guidelines.
- Track and analyze quality scores, guest satisfaction indices, and service recovery cases.
- Implement corrective action plans when standards fall below target.
- Team Leadership & Training
- Supervise, coach, and mentor housekeeping staff.
- Conduct onboarding and ongoing training on cleaning techniques, chemical usage, and safety protocols.
- Manage performance evaluations and attendance tracking.
- Promote teamwork, professionalism, and guest-centric service culture.
- Inventory & Cost Control
- Monitor linen inventory, amenities, and cleaning supplies.
- Prevent shrinkage and control operating expenses.
- Submit purchase requisitions and maintain par levels.
- Coordinate with laundry vendors or in-house laundry operations.
- Safety & Compliance
- Enforce OSHA safety standards and proper chemical handling (SDS compliance).
- Ensure adherence to sanitation and infection control procedures.
- Maintain lost-and-found logs according to property policy.
- Support internal and external audits
Customer Service Representative
Fingerhut
Tampa, FL
01.1992 - 12.1994
- Responded to customer inquiries with precision, delivering accurate catalog information, pricing, and shipping timelines to enhance information accuracy.
- Managed shipping records and processed claims for damaged or lost items, contributing to improved customer satisfaction.
Education
High School Diploma - Level 1 Tax Preparer
Liberty Tax Services
12-2013
Vocational School Certificate - Level 1 Tax Preparer
Liberty Tax Services
12-2013
Skills
- Exceptional communication
- Documentation management
- Reporting and analytics
- Mathematics skills
Certification
- Level 1 Tax Preparer, Liberty Tax Services Dec 2013
- Medical Billing And Coding, Vocational School Certificate
Languages
English
Full Professional
Timeline
Enrollment Specialist
Humana Inc
09.2025 - 12.2025
Customer Services / Enrollment Specialist
F.H Cann & Associates
11.2024 - 01.2025
Claims Examiner
Health Plan Services
01.2024 - 08.2024
Enrollment Specialist
Wipro Limited
10.2023 - 12.2023
Customer Care Representative (CCR)
Maximus Federal
01.2021 - 12.2022
Member Service Representative/Ccr1
Freedom Health Care / Anthem Inc
01.2018 - 01.2021
Customer Service Clerk
General Dynamics Info Tech
01.2014 - 12.2017
Customer Service Manager (CSM)
Mosica Vista
01.2013 - 01.2014
Construction Helper
Full Of Hope Cleaning Service
01.2010 - 01.2013
Captain
Catering by the Family
01.2005 - 12.2009
Customer Service Rep Supervisor
Vision Care Inc
01.2000 - 12.2003
Benefits Specialist
Compbenefits
01.1998 - 01.2000
Housekeeping Supervisor
Hampton Inn & Suites
01.1995 - 12.1997
Customer Service Representative
Fingerhut
01.1992 - 12.1994
High School Diploma - Level 1 Tax Preparer
Liberty Tax Services
Vocational School Certificate - Level 1 Tax Preparer
Liberty Tax Services