Jeanette Hughes
Tampa,FL
Summary
Seeking employment where my capabilities can thrive, I am an independent and reliable worker. With 16+ years of experience in the customer service industry, I have honed my skills in member/provider services, call escalations, claims inquiries, check inquiries, enrollment and disenrollment inquiries and resolutions, inbound and outbound calls, and benefit inquiries. I also possess expertise in financial services, specifically Medicare and Medicaid managed care. My ability to establish strong rapport with personnel, customers, and associates is based on my extensive knowledge, professionalism, and unwavering integrity.
Overview
24
24
years of professional experience
Work History
POET/OJT
United Healthcare
08.2018 - Current
Facilitated New Hire Training Classes. I taught a Pilot Class for Reps in Puerto Rico. OJT for New Hire classes and Refresher classes. Assisted several reps with side by side training and coaching. Provided Feedback and Quality analysis for the representatives. Collaborated with Managers and Supervisors. Received BRAVO recognition from students.
Member /Provider Services
United Healthcare
01.2009 - Current
- Claims and Check Inquiries; Enrollment; Disenrollment; Complaints
- Focus on resolving issues on the first call, navigating through the appropriate systems to identify the current status of the issue and provide appropriate response to the caller
- Claims adjustments and routing
- PRISM Project: Escalated issues from Provider Relation Reps
- Resolve complex cases and educate
- Responsible for providing research and root cause analysis for claim quality remediation
- Responsible for all aspects of quality assurance
Service Escalation Unit
Wellcare
01.2005 - 01.2009
- Member/Provider Call Escalations; Regulatory issues, AHCA, BBB, and DOI
Customer Service
Capital One
01.2001 - 01.2004
- Billing Inquiries; Lost and Stolen report processing; Up sales
Education
ENMU
12.1985
Skills
- Versatility in Teaching Styles
- Strong research skills
- Project Management
- Issue Research
- Collaboration experience
Accomplishments
Bravo Awards from Trainers and New Hires
Employee of the Month February 2021
Service Hero Award Winner 2021
Timeline
POET/OJT
United Healthcare
08.2018 - Current
Member /Provider Services
United Healthcare
01.2009 - Current
Service Escalation Unit
Wellcare
01.2005 - 01.2009
Customer Service
Capital One
01.2001 - 01.2004
ENMU