DERRAUNA CALHOUN
Dallas,USA
Summary
I am a dedicated Customer Service professional with knowledge of service delivery and proven multitasking abilities. Committed to maintaining professional relationships to increase profitability and drive business results. As a Customer Service Representative I am bringing top-notch skills in oral and written communication, active listening problem-solving skills. Also enhancing customer experience by employing service-oriented behaviors, understanding customer desires, and providing customized solutions to build loyalty.
Overview
5
5
years of professional experience
Work History
Customer Service Advocate
Centene
Remote
05.2025 - Current
- Position Purpose: Serves as the first-line advocate that focuses on resolving inquiries, issues, or concerns for members and/or providers
- Leverages a variety of communication channels to provide members and/or providers with timely, accurate, and personalized support on routine complaints
- Receives and responds to routine member and/or provider inquiries, requests and/or concerns in an accurate and timely manner
- Mitigates and prevents complaints from being escalated to resolve in initial contact
- Serves as the front-line resolution advocate on various member and/or provider inquiries, requests, or concerns
- Resolves basic problems by communicating the requested information regarding the assessment of the member or provider needs, understanding the cause, and determining if problems need to be routed to other departments for further resolution
- Maintains performance and quality standards based on established contact center metrics
- Provides customer service in a high pace contact center environment over the phone, via live chats and emails
- Documents all member or provider information and communications for quality and performance tracking through the Customer Relationship Management (CRM) applications
- Remains up-to-date and adheres to quality standards, regulation, and all other policies to ensure quality, consistency, and compliance
- Performs other duties as assigned
Customer Service Representative
Aetna, a CVS Health
Garland, TX
10.2024 - 02.2025
- Maintained focus and upheld professional standards while managing and addressing complex conflicts
- Assist individuals in understanding their Medicare & Medicaid options, including eligibility criteria, benefits and the application process
- Responded to customer requests for products, services, and company information
- Efficiently managed a high volume of inbound calls, typically 50-70 calls daily addressing customer inquiries.
- Developed strong product knowledge to provide informed recommendations based on individual customer needs
- Assisted customers in navigating company website and placing online orders, improving overall user experience
- Developed feedback system for customers to share their service experience, leading to actionable improvements
- Addressed customer inquiries to ensure satisfaction and foster positive service experience
- Resolved escalated customer issues, restoring confidence in company's commitment to service excellence
- Negotiated solutions with dissatisfied customers, turning potential negative reviews into positive testimonials
- Delivered exceptional customer service to every customer by leveraging extensive knowledge of products and services and creating welcome policies
- Investigated and resolved customer inquiries and complaints quickly
- Delivered prompt service to prioritize customer needs
- Followed up with customers about resolved issues to maintain high standards of customer service
- Educated customers about billing, payment processing and support policies and procedures
- Assisted members to understand their co-pays and deductibles
- Assisted members in finding in providers within their current health plan
Customer Service Representative
Hart Medical Equipment
Dallas, TX, USA
08.2022 - 09.2024
- Provide excellent service and support as the first point of contact for patients
- Managed incoming patient calls, addressed inquiries, and resolved issues resulting in high patient satisfaction
- Analyzing income requests for pre-authorization to determine eligibility based on the company guidelines, insurance policies and medical necessities
- Worked effectively in a fast-paced environment
- Reviewed medical bills for accuracy prior to submission to insurance companies
- Followed up with patients regarding their treatment plans as directed by physicians
- Assisted customers with scheduling appointments and follow-up care
- Communicated effectively with various departments within the organization in order to resolve customer issues quickly
- After competency approval, complete bracing as needed including: Examine, interview, and measure patients to determine their appliance needs and to identify factors that could affect appliance fit.
- Fit, test, and evaluate devices on patients, and make adjustments for proper fit, function, and comfort.
- Instruct patients in the use and care of orthoses/prostheses, diabetic shoes, and mastectomy if applicable.
- Coordinate with physicians, insurance companies and vendors to ensure timely equipment delivery
- Process and manage DME orders for home health and hospice patients.
- Confer with physicians to formulate specifications and prescriptions for orthotic and prosthetic devices.
- Verifies medical necessity, insurance coverage and physician orders for all insurance-assigned services and working with referral sources to ensure proper documentation when needed.
- Understanding and striving to meet or exceed department metrics while providing excellent customer service.
- Utilized EMR systems to track inventory billing and patient records
Customer Service Representative
Etech
Dallas, TX, USA
02.2021 - 07.2022
- Handled customer inquiries and suggestions courteously and professionally
- Actively listened to customers, handled concerns quickly and escalated major issues to supervisor
- Answered constant flow of customer calls with minimal wait times
- Investigated and resolved customer inquiries and complaints quickly
- Handles all calls according to existing guidelines, and meets department requirements for phone time availability and call quality metrics
- Met customer call guidelines for service levels, handle time and productivity
- Established knowledge of protocols, answering customer inquiries, and reducing wait times by 7+ minutes
- Provided primary customer support to internal and external customers
Customer Service Representative
NTTA
Dallas, TX, USA
06.2020 - 01.2021
- Answered calls exceeding target call rates
- Maintained a professional, friendly demeanor with customers at all times
- Set up new accounts, made account changes, and answered customer questions
- Resolved customer complaints in a timely manner
- Assist customers by taking payments for outstanding invoices and with any issues or questions they may have and help manage their Toll Tag accounts
- Achieves production goals and standards for servicing accounts without sacrificing quality of service.
- Assisted customers with product selection, ordering, billing, returns, exchanges and technical support
- Ensured customer satisfaction through effective problem resolution
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Handled PCI Data confidentially and securely.
Education
Diploma - undefined
H Grady Spruce Highschool
Dallas, TX05.2020
Skills
- Customer service
- Active listening
- Critical thinking
- DME processing
- HIPAA compliance
- Knowledge of medical coding
- Data entry
- Problem resolution
- Call center experience
- Conflict resolution
- Complaint handling
- Microsoft Excel
- Payment processing
- Professional telephone demeanor
- Microsoft outlook
- Scheduling
- Follow-up skills
- Call management
- Product knowledge
- Order processing
- Team development
- Documentation
- Administrative support
- Data collection
- Spreadsheets
- Reading comprehension
- Microsoft PowerPoint
- Customer education
- Multi-line phone talent
- Coordination
- Relationship building
- Computer proficiency
- Complaint resolution
- Call center operations
- Customer satisfaction measurement
- Appointment scheduling
- Customer relationship management (CRM)
- Prioritization
- De-escalation techniques
- Research
- Teamwork and collaboration
- Friendly, positive attitude
- Time management
- Attention to detail
- Flexible and adaptable
- Dependable and responsible
- Multitasking Abilities
- Excellent communication
- Computer skills
- Organizational skills
Timeline
Customer Service Advocate
Centene
05.2025 - Current
Customer Service Representative
Aetna, a CVS Health
10.2024 - 02.2025
Customer Service Representative
Hart Medical Equipment
08.2022 - 09.2024
Customer Service Representative
Etech
02.2021 - 07.2022
Customer Service Representative
NTTA
06.2020 - 01.2021
Diploma - undefined
H Grady Spruce Highschool