Compassionate and detail-oriented Customer Service Representative with 4 years of experience supporting Medicaid and commercial healthcare members through high-volume call centers. Proven ability to navigate claims, eligibility, and benefits questions while maintaining HIPAA compliance and ensuring member satisfaction. Adept at resolving complex issues, documenting inquiries accurately, and collaborating across departments to deliver efficient, member-first service.
-Delivered HIPAA-compliant phone support for health insurance members with inquiries on benefits, eligibility, and claims processing.
- Resolved high-complexity issues regarding referrals, coverage gaps, and appeals with empathy and accuracy.
- Collaborated with departments such as Utilization Management and Claims to expedite issue resolution and provide a seamless member experience.
- Achieved and maintained high call quality scores and productivity metrics in a fast-paced remote work environment.
-Responded to Medicaid member inquiries regarding application status, plan details, and provider availability across multiple states.
- Managed high call volumes while maintaining compliance and call accuracy standards.
- Documented all conversations and actions in internal systems to ensure continuity of care and issue resolution.
- Exceeded call handling goals consistently while remaining patient-focused.
- Provided in-person customer service support, with a focus on account setup, financing, and post-sale issue resolution.
- Handled sensitive customer financial data and maintained documentation of purchase agreements.
- Developed skills in upselling, account management, and maintaining strong client relationships.
-HIPAA Awareness Training (2024)
- Customer Service Excellence Training – BlueCross BlueShield
- Conflict De-escalation & Empathy in Healthcare (internal training)