Open To Work
Kristy Brumley
Arlington,TX
Work Preference
Summary
Detail-oriented Customer Service Specialist skilled in data analysis and claims processing. Enhanced customer satisfaction by identifying operational trends and implementing targeted solutions. Collaborated with cross-functional teams to adapt strategies for evolving needs, driving client loyalty and retention. Proven ability to prioritize and manage multiple tasks in fast-paced environments while effectively resolving escalated support issues.
Overview
1
1
Certification
13
13
years of professional experience
Work History
Tri-west Customer Service Rep
Impact Technology
03.2025 - Current
- Facilitate the healthcare needs of the military population by resolving inbound inquiries via calls, chat, and email regarding enrolments, claims, referrals, authorizations, and appointments.
- Resolved customer complaints through effective problem-solving techniques, enhancing customer satisfaction.
- Manage high-volume workload independently, while strictly adhering to published schedules and performance metrics.
- Participated in continuous advanced training to maintain proficiency in resolving complex customer issues, ensuring high-quality service.
- Collaborated with cross-functional teams to streamline communication, improving service delivery processes.
- Navigate a multi-system Microsoft environment and proprietary software simultaneously to document customer interactions accurately within the CRM systems, and work in Salesforce, Care Radius systems alike.
Customer Services/ Repeat Caller /Claims Specialist
United Healthcare Group /Optum RX
02.2021 - 02.2025
- Served as client-facing point of contact, managing patient intake, updating files, booking appointments, and resolving escalated inquiries for improved service.
- Maintained records of customer interactions and transactions, detailing inquiries and comments for accurate tracking.
- Researched, coded and processed complex health claims, ensuring meticulous accuracy in calculating benefits due, issuing payments, or executing denials
- Guided healthcare providers through appeals process for adverse benefit determinations and coverage decisions, ensuring understanding and compliance.
- Onboarded and managed custom corporate clients, overseeing cross-functional teams and multiple concurrent projects to ensure timely, regulatory-compliant submissions
- Maintained strict compliance with internal company policies and federal HIPAA privacy regulations
- Maintained up-to-date knowledge of healthcare policies and procedures.
Benefit Specialist-Consultant/ Implementation-Analyst
CVS Health, Irving, TX
Irving, Texas
09.2013 - 03.2019
- Partnered with corporate clients to assess business needs and implement customized health, welfare, and retirement benefits programs that align with employee strengths.
- Interpreted complex benefit plans and provided compliance guidance to HRIS representatives, managers, and service providers.
- Collaborated with legal counsel and consultants to review benefits regulations and ensure compliance with state and federal laws.
- Compiled and analyzed marketplace and plan financial data to inform strategic long-term benefits planning.
- Coordinated open enrollment processes and facilitated communication between employees and insurance providers to ensure clarity and accessibility.
- Conducted detailed financial accounting audits and monitored third-party vendor services and levies to ensure fiscal efficiency
- Provided support in processing prescriptions, ensuring accuracy and compliance with regulations.
Education
High School Diploma -
Jasper High School
Jasper, TX05-1994
No Degree - Criminal Justice
Navarro County College
Midlothian, TXNo Degree - Healthcare Administration
University of Phoenix
Phoenix, AZSkills
- Healthcare software proficiency
- CRM software navigation
- Healthcare compliance
- Patient confidentiality
- Appointment scheduling
- Process adherence
- Attention to detail
- Problem solving
- Customer engagement
- Customer feedback
- Verbal and written communication
- Team collaboration
- Conflict resolution
- Sense of urgency
- Proactive initiative
- Quick learner
- Critical thinking
Accomplishments
- Telephone Service - Professionally processed 80+ calls per day, providing information and service to ensure customer satisfaction.
- Conflict Resolution - Responsible for handling customer account inquiries, accurately providing information to ensure resolution of product/service complaints and customer satisfaction.
- Conflict Resolution - Accountable for managing customer account inquiries, accurately delivering information to ensure the resolution of product/service issues and customer satisfaction.
Certification
- Certified Pharmacy Technician
- CPR, Certified Medication and Nurse Aid
- Yellow Belt (Six Sigma)
- Med-D Trained
References
Nancy Cordero -Triwest Supervisor Contact Operations
15810 N 28th Avenue, Phoenix AZ 85053
email: ncordero@triwest.com
Phone: 915-702-7246
Sharcondria Salone - Specialist Tax Sales Client Operations
3001 Hackberry Drive, Irving Texas 75063
email: ssalone@corelogic.com
Phone: 817-699-3877
Languages
English
Timeline
Tri-west Customer Service Rep
Impact Technology
03.2025 - Current
Customer Services/ Repeat Caller /Claims Specialist
United Healthcare Group /Optum RX
02.2021 - 02.2025
Benefit Specialist-Consultant/ Implementation-Analyst
CVS Health, Irving, TX
09.2013 - 03.2019
High School Diploma -
Jasper High School
No Degree - Criminal Justice
Navarro County College
No Degree - Healthcare Administration
University of Phoenix