Diana Hawkins
Brooks,KY
Summary
Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
5
5
years of professional experience
Work History
Grievance and Appeals Representative 3
Humana Insurance Company
Louisville, KY
11.2022 - 08.2024
- Assessed appeals and grievances to determine eligibility for reconsideration or review.
- Collaborated with health care providers, members, and other stakeholders to resolve issues in a timely manner.
- Conducted research on complex cases to ensure accurate resolution of appeals and grievances.
- Facilitated communication between members, providers, internal departments, and external organizations regarding appeals inquiries.
- Maintained accurate records of all appeal activities including documentation of decisions rendered by higher levels of review.
- Monitored incoming correspondence from members, providers, employers, state agencies. to ensure timely response to inquiries.
- Updated departmental databases with information pertaining to each case reviewed.
- Verified that all documentation was complete before rendering a final decision.
- Worked closely with auditing teams throughout the appeals process.
Inbound Call Center Representative
Humana Insurance Company
Louisville, KY
01.2021 - 11.2022
- Answered incoming customer calls regarding product inquiries, orders, complaints and general customer service.
- Assessed customer needs and provided solutions to resolve their issues in a timely manner.
- Processed customers' orders over the phone and provided follow-up services to ensure satisfaction with products or services.
- Provided accurate information about products or services to customers.
- Maintained records of customer interactions and transactions for future reference.
- Researched required information using available resources.
- Identified and escalated priority issues as needed.
- Assisted Medicare members with seeing if they qualified for temporary Prescription coverage under the Limited Income Net (LINET) Program
- Complied with quality assurance standards while handling customer inquiries.
- Utilized computer technology to handle high volume of calls in a timely manner.
- Assisted other team members when needed during peak hours of business operations.
- Listened attentively to customer concerns and provided appropriate solutions within the time limits.
- Answered incoming calls and provided highest level of professionalism and knowledgeable service to every customer.
Enrollment Specialist
Humana Insurance Company
Louisville, KY
10.2020 - 01.2021
- Updated member's requested plan and provider during Medicare's open enrollment.
- If member's request provider was unavailable assigned an eligible provider to member and sent a letter with updated provider information to member as well as information on how to change plan or provider.
Real Estate Sales Associate
Schuler Bauer
Elizabethtown , KY
09.2019 - 10.2020
- Conducted market research to identify trends and potential customers.
- Developed relationships with key stakeholders in the real estate industry.
- Advised clients on property values, taxes, zoning regulations, mortgages and legal requirements.
- Organized open houses and other events to promote properties for sale.
- Prepared documents such as listing agreements, purchase contracts, closing statements and deeds.
- Negotiated contracts between buyers and sellers of real estate.
- Assisted clients in obtaining financing from banks or other lending institutions.
- Provided guidance to clients throughout the entire home buying process.
- Collaborated with agents, brokers and other professionals to facilitate successful transactions.
- Generated leads through cold calling, referrals and networking activities.
- Maintained accurate records of all transactions including sales data, client contact information and listing details.
- Analyzed financial data related to property appraisals, loan applications and mortgage payments.
- Attended conferences and seminars to stay abreast of changes in the real estate market.
- Resolved customer complaints regarding properties purchased or sold by providing timely solutions.
- Listed properties for sale using multiple platforms such as print media or online listings.
- Identified desirable features of potential homes based on client preferences.
- Created marketing materials such as brochures or flyers advertising available properties.
- Inspected condition of properties prior to listing them for sale or lease.
Education
High School Diploma -
Holy Cross High School
Louisville, Ky05-2003
Skills
- Legal knowledge
- Policy Interpretation
- Insurance knowledge
- Microsoft Office
- Multitasking skills
- Goal Setting
- Conflict Resolution
- Strategic Planning
- Analytical Thinking
- Interpersonal Skills
- Active Listening
- Task Prioritization
- Time Management
- Professionalism
- Problem-solving abilities
Timeline
Grievance and Appeals Representative 3
Humana Insurance Company
11.2022 - 08.2024
Inbound Call Center Representative
Humana Insurance Company
01.2021 - 11.2022
Enrollment Specialist
Humana Insurance Company
10.2020 - 01.2021
Real Estate Sales Associate
Schuler Bauer
09.2019 - 10.2020
High School Diploma -
Holy Cross High School