Lakesha Roberts
Texas Children's Health Plan
Houston,TX
12
years of professional experience
Results-driven healthcare professional with 12+ years of experience in managed care, provider services, quality assurance, and training. Skilled in resolving complex provider issues, supporting claims and authorization processes, delivering educational initiatives, and collaborating across teams to improve provider satisfaction, compliance, and operational performance.
Work History
Call Quality Analyst
3 Years 10 Months- Evaluate call quality to ensure compliance with quality standards, departmental policies, and standard operating procedures.
- Collaborated with leadership to identify performance trends, implemented corrective actions, supported continuous process improvement initiatives, and delivered performance feedback to enhance team outcomes.
- Research operational challenges and recommend solutions to improve quality performance and overall departmental effectiveness.
- Partner with internal departments to improve provider satisfaction and service excellence.
- Researched operational challenges and recommended solutions to improve quality performance and increase departmental effectiveness.
- Develop, maintain, and facilitate comprehensive training programs for Provider Services Representatives.
- Created educational materials, job aids, reference guides, and process documentation to enhance provider-related operations and facilitate staff development.
Senior Call Center Representative
4 Years- Provided exceptional support to providers regarding benefits, claims status, prior authorizations, and healthcare plan processes while consistently meeting performance goals.
- Researched provider and member inquiries, ensuring accurate and efficient resolutions.
- Conducted in-depth research to resolve provider and member inquiries accurately and efficiently.
- Identified process improvement opportunities, collaborating with leadership to enhance operational workflows and service delivery.
- Trained new employees as a credentialed trainer during EPIC implementation and assisted leadership with onboarding and mentoring.
Insurance Services Associate
10 Months- Addressed client inquiries on insurance policies, delivering accurate and timely information to enhance client understanding.
- Responded to client inquiries regarding insurance policies while providing accurate and timely information.
- Maintained a high level of customer service while resolving member concerns and policy-related questions.
- Provided high-quality customer service by resolving member concerns and answering policy-related questions effectively.
Client Services Representative
2 Years 5 Months- Administered health and welfare benefits for multiple corporate clients, including Fortune 500 organizations.
- Identified service trends and opportunities for process improvement via client listening sessions and quality monitoring, enhancing overall client satisfaction.
- Acted as a liaison between clients, carriers, healthcare providers, and internal departments to facilitate issue resolution.
- Maintained and updated organizational knowledge management resources, supporting team access to crucial information.
Education
- Coursework in Healthcare Administration 1999-2003
High School Diploma
Skills
Provider Relations & Education
Healthcare Operations
Claims & Prior Authorization Support
Provider Enrollment
Quality Assurance & Regulatory Compliance
Customer Service Excellence
Conflict Resolution
Cross-Functional Collaboration
Strategic Problem Solving
EPIC Credentialed Trainer
Microsoft Office Suite
Timeline
Call Quality Analyst
Texas Children's Health Plan
10.2022 - CurrentRead More
Senior Call Center Representative
Texas Children's Health Plan
10.2018 - 10.2022Read More
Insurance Services Associate
IQOR
12.2017 - 10.2018Read More
Client Services Representative
Empyrean Benefit Solutions
09.2014 - 02.2017Read More
Sam Houston High School
High School Diploma
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University of Houston-Downtown
from Coursework in Healthcare Administration 1999-2003
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