KIMBERLY McClelland
Dallas,TX
Summary
Empathetic Customer Experience Specialist known for high productivity and efficiency in task completion. Possess specialized skills in customer relationship management, conflict resolution, and data-driven decision-making. Excel at communication, problem-solving, and adaptability, ensuring top-notch customer satisfaction. Detail-oriented, with proficiency in advanced Microsoft software applications, striving to enhance productivity and efficiency within the team.
Overview
17
17
years of professional experience
Work History
Customer Experience Specialist III
Molina Healthcare
Long Beach, CA
03.2020 - 03.2025
- Analyzed and input health assessments to identify medical and behavioral health concerns among members.
- Handled customer phone calls efficiently to prevent on-hold delays.
- Resolved members' online access problems through active listening and data collection.
- Utilized Salesforce to document member inquiries and complaints by obtaining pertinent details, while investigating the matter and determining resolution.
- Coordinated outbound communication with provider offices, hospital billing departments, and collection agencies to address outstanding medical accounts.
- Oversaw the enrollment process for residents across diverse regions into Molina Healthcare services.
- Facilitated comprehension of Molina Healthcare policies, procedures and plan details through concise explanations.
- Acted as a liaison between members and pharmacies to resolve prescription discrepancies.
- Maintained the confidentiality of members and the company's PHI, as well as followed all HIPAA regulations.
- Provided crisis intervention services when needed, by utilizing de-escalation techniques, or referring clients to appropriate professionals for further assistance.
- Supported healthcare professionals and members by delivering accurate claim status updates.
Sr. Clinical Administrative Coordinator
UnitedHealth Group
Minneapolis, MN
08.2016 - 11.2019
- Generated patient documentation, including charts and consent forms meticulously.
- Communicated with physician offices to confirm patient health status and provide updates regarding insurance eligibility.
- Ensure that the Health Insurance Portability and Accountability Act (HIPAA) codes were not violated, and that all required documentation was up to date when relaying sensitive information.
- Obtained vital information about patients' medical history, complaints, and allergies.
- Performed clerical duties such as word processing, data entry, answering phones, and filing.
- Collaborated with clinical team members regarding the administration and filing of patient referrals and service authorization.
- Managed calendars for multiple nurses by arranging necessary appointments for their high-risk OB patients.
- Monitored patient care to ensure adherence to established clinical guidelines and standards.
- Assisted with the coordination of scheduling and maintaining patient appointments.
- Kept records current in alignment with auditing needs.
- Ensured efficient shipment of necessary medical supplies for patient treatment.
- Skilled in navigating AS400 system.
Lead Quality Assurance Analyst
Certified Payment Processing
Carrollton, TX
06.2008 - 08.2016
- Monitored employee appointment-setting calls to determine that the accuracy of company information is being given to the consumer in accordance with accepted standards.
- Meet or exceed a count of 150 validated appointments daily, which includes manually entering completed calls via an Excel spreadsheet and documenting findings.
- Coordinate with management for coaching opportunities that are essential to employee advancement.
- Lead new hire training classes to ensure that Quality Assurance processes and procedures are discussed and understood.
- Created, edited, and updated project manuals and technical documentation used by the entire QA team.
- Conducted internal audits to measure adherence to established QA standards.
- Drafted detailed reports outlining product performance issues, risks, recommendations and resolutions.
- Participated in continuous team-building improvement to enhance product quality and team performance.
Education
Lincoln Humanities/Communications Magnet High School - Dallas, Tx -
High School Diploma
2006
Some College (No Degree) -
The University of Texas At Arlington
Arlington, TXSkills
- Experienced user of Microsoft Office tools
- Effective verbal communication
- Analytical problem solver
- Detail-oriented organizer
- Effective time management
- Execution of operational processes
- Skilled in diagnosing issues
- Collaborative leadership
- Comprehensive administrative services
- Accurate documentation skills
- HIPAA compliance expertise
- Skilled in multitasking across multiple screens
- Data entry accuracy with proficient typing experience
Timeline
Customer Experience Specialist III
Molina Healthcare
03.2020 - 03.2025
Sr. Clinical Administrative Coordinator
UnitedHealth Group
08.2016 - 11.2019
Lead Quality Assurance Analyst
Certified Payment Processing
06.2008 - 08.2016
Lincoln Humanities/Communications Magnet High School - Dallas, Tx -
High School Diploma
Some College (No Degree) -
The University of Texas At Arlington
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