Summary
Overview
Work History
Education
Skills
Accomplishments
Timeline
References
Generic

GLORIA BILLY

Spring,TX

Summary

Dedicated professional with strong experience in managing client relationships and ensuring satisfaction. Skilled in team collaboration and communication, consistently achieving results through adaptability and problem-solving. Proficient in conflict resolution, project management, and fostering positive client experiences. Reliable and flexible, with focus on meeting organizational goals and exceeding client expectations.

Overview

10
10
years of professional experience

Work History

Client Service Manager

United Healthcare
07.2022 - 10.2024
  • Optimized customer service operations, enhancing loyalty and retention metrics.
  • Managed client relationships through effective email and chat support, ensuring satisfaction.
  • Assisted clients with EOB's, claims including superbills, and appeals process/review as applicable to the need of client/client employee.
  • Delivered timely updates to clients on project status changes and service requests.
  • Resolved customer complaints using strong communication skills, building positive relationships.
  • Collaborated with sales, marketing, and product development teams for on-time service delivery.
  • Explored innovative technologies to improve customer service processes and efficiency.
  • Demonstrated multitasking and prioritization in fast-paced environments while meeting deadlines.

Case Management Specialist

United Healthcare
04.2021 - 07.2022
  • Implemented HEDIS screening measures, ensuring compliance with NCQA guidelines for customer assistance.
  • Optimized workflows for claims and appeals for customer service teams while enhancing training processes.
  • Developed comprehensive training materials to boost departmental effectiveness and performance.
  • Trained team members on accessing community resources via live and work well system.
  • Supported projects aligned with operational goals to enhance member efficiency across departments including eligibility and claims.
  • Assisted members with various topics when outreached including claims or appeal inquiries.
  • Maintained accuracy of patient information in EHR system to uphold data integrity.

Outreach Coordinator

Amerigroup
05.2019 - 04.2021
  • Conducted outreach to members via live and work queues to ensure resource applicability.
  • Processed assessments and sourced resources for members regarding DME, prescriptions, housing, and supplies.
  • Served as team leader, facilitating various projects and calibrations while supporting peers and management.
  • Provided assistance to members through chat, phone calls, and virtual meetings for timely support and follow-ups.
  • Functioned as Delivery Assistant for three Texas new hire classes, serving as interim trainer for one.
  • Managed entry of new hire information into database, including supervisor and system access assignments.
  • Updated agent queues to accommodate call center volume, ensuring optimal service delivery.
  • Collaborated with business managers to present daily, weekly, and monthly goals at state meetings.

Texas Benefits/Advocate4Me Representative

United Healthcare
07.2015 - 05.2019
  • Assisted with member escalations by analyzing and reviewing EOB's, claims, and appeals.
  • Facilitated appointment scheduling and provider look-ups, enhancing member service.
  • Handled customer complaints quickly and professionally to restore customer confidence and prevent loss of business.
  • Delivered technical support for member inquiries, boosting customer satisfaction.
  • Assisted various departments in project management and establishing best practices.
  • Trained and mentored new hires to ensure effective onboarding processes.
  • Engaged in continuous learning to maintain up-to-date industry knowledge.
  • Assisted providers with claims and authorization status inquiries.
  • Collaborated with workforce management on scheduling and queue monitoring.

Comcast

Customer Service Rep
01.2015 - 07.2015
  • Handled inbound calls related to installation, new services, billing, and technical issues.
  • Assisted accounts with urgency to resolve customer inquiries effectively.
  • Managed high volume of customer accounts while ensuring accurate record-keeping.
  • Demonstrated strong verbal and written communication skills in professional interactions.
  • Completed all required training sessions to enhance service delivery.
  • Achieved monthly performance metrics consistently to meet organizational standards.

Education

Some College (No Degree) - Business Management

West TX A&M

Business Management -

Southern University A&M

High School Diploma -

Robert E. Lee High School

Skills

  • Quality assurance
  • Process improvement
  • Compliance management
  • Conflict resolution
  • EOB review
  • Claims processing and review
  • Appeals and Grievance processing and review
  • Task prioritization
  • Client relationships
  • Team development
  • Report generation
  • Project facilitation
  • Adaptability and flexibility
  • Relationship building
  • Managing operations and efficiency
  • Time management
  • Project Management
  • Effective problem solving
  • Training and development
  • Team collaboration
  • Attention to detail
  • Organizational skills
  • Cross-functional coordination
  • Data analysis
  • Leadership skills
  • Empathy and understanding
  • Analytical mindset

Accomplishments

  • Meets goal of 100 percent in Quality.
  • Meets goals to receive quarterly QVC.
  • Team Jackson Leadership Team.
  • LEET (Local Employee Engagement Team).
  • Culture Ambassador & Sugar Land Innovation Committee.
  • Delivery Assistant for 3 new hire classes and interim trainer for 1 new hire class.
  • Workforce intern.
  • Training intern.

Timeline

Client Service Manager

United Healthcare
07.2022 - 10.2024

Case Management Specialist

United Healthcare
04.2021 - 07.2022

Outreach Coordinator

Amerigroup
05.2019 - 04.2021

Texas Benefits/Advocate4Me Representative

United Healthcare
07.2015 - 05.2019

Comcast

Customer Service Rep
01.2015 - 07.2015

Business Management -

Southern University A&M

High School Diploma -

Robert E. Lee High School

Some College (No Degree) - Business Management

West TX A&M

References

  • Trevor Jackson - United Healthcare C&S TX Health plan Provider Relations Advocate
  • Marco Molina Guerra - United Healthcare Member Advocate
  • Annette Powell - United Healthcare Business Manager

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