DIANA PRESSEY
Wimauma,FL
Summary
Certified Health Insurance Agent with experience in providing customer-focused insurance solutions. Skilled at navigating complex healthcare regulations, delivering clear and concise information to clients, and managing relationships with both customers and insurance providers. Strengths include understanding health insurance policies, communicating effectively, problem-solving, and making significant contributions in previous roles by improving client retention rates.
Overview
1
1
Language
1
1
Certification
13
13
years of professional experience
Work History
Medicare Licensed Health Insurance Agent
WellCare, Inc
Tampa, FL
07.2023 - 09.2026
- Assess prospective health needs and explain Medicare Advantage benefits, and guide consumer step by step to complete enrollment application.
- Handled inbound and outbound calls to identify prospective enrollees and verify Medicare eligibility, enhancing customer conversion rates.
- Ensured sales presentations adhered to CMS compliance and regulations, maintaining integrity of enrollment process.
- Ensured compliance with disclosure requirements for Medicare Advantage offerings.
- Documented customer interactions and updated data using CRM software, facilitating accurate record-keeping and follow-up.
- Met or exceeded individual monthly sales and quality goals.
- Assisted clients with enrollment in WellCare health insurance programs.
- Educated clients on health insurance options and coverage plans.
- Collaborated with team members to enhance customer service strategies.
- Conducted follow-up calls to ensure client satisfaction with services provided.
- Stayed updated on industry regulations and WellCare policy changes.
- Provided detailed explanation of policy terms, conditions, and benefits to clients.
- Participated in training sessions as required by company guidelines.
- Provided support during open enrollment periods by answering inquiries from potential customers.
- Educated customers on various health insurance products and services available.
- Monitored changes in state and federal laws regarding health insurance policies.
- Developed and implemented insurance plans for customers based on their individual needs.
- Created individualized proposals for clients to include coverage options, premiums and enrollment guidelines.
- Met with division leaders and consultants to discuss strategies to increase sales.
Medicare Licensed Health Insurance Agent
TZ Insurance Solution LLC
Tampa, FL
09.2020 - 05.2023
- Provided empathetic and concise insurance quotes and education to clients, effectively representing multiple insurance companies.
- Performed a needs analysis to determine the most suitable product for the customer and facilitated their enrollment.
- Educated clients on health insurance options and facilitated migration to plans with manageable costs and desired benefits.
- Assisted customers in understanding their health insurance policies tailored to individual needs.
- Handle inbound and outbound phone calls from prospective members wanting more information on plans.
- Communicated with clients in a clear and compassionate manner during consultations.
- Displayed excellent customer service while multitasking effectively in a fast-paced environment.
Care Coordinator – Telephonic
WellCare, Inc
Tampa, FL
05.2017 - 10.2020
- Conducted telephonic outreach to members, ensuring compliance with quality improvement, regulatory, and contractual standards.
- Schedules doctor appointments for all household members with care gaps with the Primary Care Physician (PCP) and/or Specialist to access needed preventive care services and close gaps in care via a three-way phone call.
- Educated members and their families on preventive health screenings and identified barriers to accessing care.
- Informs providers about the care gap(s) member has and why they are seeing the provider.
- Coordinated transportation services for members to ensure access to healthcare appointments.
- Collaborated with Customer Service and other departments to resolve member issues effectively.
Health Care Coordinator - Telecommute
Humana, INC
Tampa, FL
06.2016 - 04.2017
- Conducted telephonic outreach to assess health, environment, nutrition, and psycho-social concerns for assigned members, utilizing diverse assessments to identify needs.
- In response to assessments, coach and problem solve with member to identify and address specific goals to support health and behavior change.
- Collaborated with Humana Cares interdisciplinary team members, including care managers and community health educators, to ensure comprehensive support for members.
- Provided targeted interventions to enhance health and wellbeing, including education and coordination of community-based support services and national resources.
Customer Care Specialist – Telecommute
Humana, INC
Tampa, FL
08.2014 - 06.2016
- Responded to customer inquiries via phone
- Documented customer inquiries using best practices to ensure accurate record-keeping
- Empathize and build lasting relationships with customers
- Educated customers on products and services, enhancing their understanding and satisfaction
- Complied with all HIPPA and CMS regulations
- Scheduled medical appointments and arranged transportation for patients and caregivers to facilitate care access
Authorization and Collection Specialist
Global Neuro & Spine Institute
Jensen Beach, FL
01.2014 - 01.2014
- Requested authorization for patient procedures to ensure timely access to necessary treatments
- Insurance Verification and benefits
- Managed billing documentation and records, processing payments to maintain accurate financial records
- Billing
Education
Diploma - Medical Billing and Coding
Fortis Institute
Port St Lucie, FL06-2014
Bachelor of Arts - Business Administration
University of Panama
Panama Republic Of Panama12-1997
Skills
- Enrollment guidance Upselling/Cross-sellingMedicare expertise
- Medicaid expeHealth insurance knowledgeS codes,Claims processing
- Policy analysis
- Policy comparison
- Health plans
- CPT codes
- Insurance policy sales medical PCS codes
- CRM software
- Customer interaction documentation
- Call center operations
- Inbound call management
- Enrollment processing
- Health plan enrollment
- Client relationship management
- Upselling/Cross-selling
- Objection handling
- Follow-up skills
- Effective communication
- Empathetic listening
- Conflict resolution
- Needs assessment
- Analytical skills
- Problem solving
- Critical thinking
- Compliance
- Healthcare regulations
- Service oriented
- Call center service
- Lead coordination
- Administrative tasks
- Licensing requirements
- Flexibility
- Product promotion
- Health insurance
- Needs analysis
- Problem solving
- Call center service
- Service oriented
- Critical thinking
- Product promotion
- Insurance policy sales
Languages
Spanish
Professional
Certification
- Health License
Timeline
Medicare Licensed Health Insurance Agent
WellCare, Inc
07.2023 - 09.2026
Medicare Licensed Health Insurance Agent
TZ Insurance Solution LLC
09.2020 - 05.2023
Care Coordinator – Telephonic
WellCare, Inc
05.2017 - 10.2020
Health Care Coordinator - Telecommute
Humana, INC
06.2016 - 04.2017
Customer Care Specialist – Telecommute
Humana, INC
08.2014 - 06.2016
Authorization and Collection Specialist
Global Neuro & Spine Institute
01.2014 - 01.2014
Diploma - Medical Billing and Coding
Fortis Institute
Bachelor of Arts - Business Administration
University of Panama