Duke Thomas
Hudson,FL
Summary
Service Escalation Account Manager
Dynamic and cheerful Service Escalation Account Manager with a proven track record of taking on additional responsibilities to achieve team objectives. Skilled in developing and nurturing fruitful customer relationships through exceptional interpersonal abilities. Adept at balancing client requirements with organizational goals to foster mutually beneficial agreements. Focused communicator dedicated to enhancing service applications to maximize customer engagement and satisfaction. Highly organized and dependable, with strong collaborative skills and the ability to manage multiple projects simultaneously with precision and accuracy.
Overview
7
7
years of professional experience
1
1
Certification
Work History
Service Escalation Account Manager
United Healthcare
03.2024 - Current
- Managed supervisor calls focused on addressing and resolving complex issues
- De-escalating customer concerns to ensure satisfaction and retention.
- Supporting advocates in diverse tasks to enhance service delivery
- Coordinate and share newsletters to keep team updated.
- Employing Excel for data analysis and creating reporting spreadsheets
- Proficiency in Microsoft Word
- Skilled in PowerPoint presentations
- Experience researching and resolving pharmacy claims and/or customer service issues
- Experience presenting information in internal meetings
- Organizing and maintaining information in OneNote for easy access.
- Handling claims processing and ensuring accuracy.
- Coordinating PCP (Primary Care Provider) changes for clients.
- Experience collaborating with service teams, sales and health plans, leadership, and internal business partners
- Managed approximately 30 incoming calls, emails and faxes per day from customers.
Advocate4me Rep Sr/Service Navigator
United Health Care
09.2022 - 03.2024
- Provides telephonic outreach to Medicaid members to complete social determinants of health assessments. Educates member on gaps in care and assists with scheduling provider appointments.
- Assists members with social determinants of health and links to community resources. Ensures member has access to PCP. Identifies gaps in care and assists in closure of gaps. Outreaches members on caseload consistent with program guidelines.
- Consistently meets metrics, both quality & performance. Provides excellent customer service to both members and providers. Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members.
- Proficiency in Excel and PowerPoint
- Streamlined operations and prioritized tasks, allowing senior staff to increase revenue by 25%
- Experience engaging with service teams, sales and healthcare plans, leadership
- Experience researching and resolving pharmacy claims and/or customer service issues
- Exceeded performance targets through diligent work ethic and focus on results-driven tasks.
Customer Service Representative
Wipro Health Plan Services
02.2021 - 08.2022
- Analyzed and processed rejected claims by investigating and gathering information to determine the error on the claims. Assessed & resolved claims within evaluation. Negotiates settlement of claims up to designated authority level and makes claim paid. Calculated and assigned timely & appropriate reserves to claims and continues and continues to monitor reserve adequacy throughout the life of the claim.
- Managed all Medicare billing and collections transactions and communicated with personnel at various local offices. Provided exceptional customer service by answering questions, explaining services, and ensuring total satisfaction with the handling of each transaction.
- Managed approximately 50 incoming calls, emails and faxes per day from customers.
CS Representative
Maximus Health Services
09.2018 - 01.2021
- Handled Medicare inquiries regarding premiums, unpaid bills, and plan changes.
Resolved customer issues while ensuring calm communication and effective solutions.
Enhanced customer retention through exemplary service and targeted improvement programs.
Recommended features, accessories, upgrades, and options based on customer needs.
Responded to customer inquiries with confidence and accuracy in a timely manner.
Evaluated data to determine appropriate resolution strategies for service recovery.
Navigated multiple systems efficiently to deliver optimal service outcomes. - Managed urgent situations swiftly to analyze and redirect issues.
- Processed high volume of customer calls with efficient wait time management.
- Learned and followed all organizational policies and procedures to maintain safe and professional working environments.
Education
Bachelor of Science - Business Administration
Capella University
Nordland, WA02-2034
High School Diploma -
Smart Horizon
Pompano Beach, FL01.2019
Skills
- Fast learner
- Data Entry
- Excel
- Problem solving
- Quality Control
- Powerpoint
- Medical terminology
- HIPAA
- Quality Audits
- Quality Assurance
- Negotiation
- Relationship building
- Strategic planning
- Goals and performance
- Documentation and reporting
Accomplishments
Dynamic and cheerful Service Escalation Account Manager with a proven track record of taking on additional responsibilities to achieve team objectives. Skilled in developing and nurturing fruitful customer relationships through exceptional interpersonal abilities. Adept at balancing client requirements with organizational goals to foster mutually beneficial agreements. Focused communicator dedicated to enhancing service applications to maximize customer engagement and satisfaction. Successfully managed the creation and distribution of monthly PowerPoint newsletters, resulting in a 20% increase in readership and engagement through innovative design and presentation techniques. Developed engaging content, coordinated with various departments, and ensured timely delivery of high-quality newsletters. Consistently maintained excellent metrics and adherence to company standards, demonstrating strong collaborative skills and the ability to manage multiple projects simultaneously with precision and accuracy.
Certification
M&R CERTIFIED L1-3
Timeline
Service Escalation Account Manager
United Healthcare
03.2024 - Current
Advocate4me Rep Sr/Service Navigator
United Health Care
09.2022 - 03.2024
Customer Service Representative
Wipro Health Plan Services
02.2021 - 08.2022
CS Representative
Maximus Health Services
09.2018 - 01.2021
Bachelor of Science - Business Administration
Capella University
High School Diploma -
Smart Horizon
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