Summary
Overview
Work History
Education
Skills
Timeline
Generic

LaKiera Gaines-Clifton

Prattville,AL

Summary

Dynamic professional with a proven track record at Peachgrove BC, excelling in client intake and eligibility evaluation. Skilled in data entry and elite customer service, I effectively enhance provider verification processes and customer satisfaction. Demonstrated success in improving operational efficiency by over 30%, leveraging strategic problem resolution and records management expertise.

Overview

11
11
years of professional experience

Work History

Member Service Representative

Contractor with OmniCare365 at UnitedHealthCare
Richardson, TX
11.2024 - Current
  • Contracted to work with UnitedHealthCare Dual Plans
  • Handled customer complaints in an efficient and courteous manner.
  • Adjusted bills and refunded money to resolve customers' service or billing complaints.
  • Answered member questions about products and services.
  • Helped members resolve account problems and navigate internal systems to handle routine needs.
  • Engaged in conversation with customers to understand needs, resolve issues and answer product questions.
  • Enhanced member relationships by providing excellent service during each interaction.
  • Greeted customers in a friendly and professional manner.
  • Increased customer satisfaction ratings by effectively answering
    questions, suggesting effective solutions, and resolving issues quickly.

Intake Specialist

Peachgrove BC
Guyton, GA
01.2021 - Current
  • Initial Verification of Provider Files: Thoroughly review and verify the authenticity, accuracy, and completeness of provider documents and files.
  • OIG Query: Conduct queries against the Office of Inspector General's database to check for provider exclusions or sanctions.
  • SAM Query: Perform System for Award Management (SAM) queries to ensure that providers are not debarred or excluded from participating in federal programs.
  • Update Provider's CAQH Accounts: Maintain and update provider information in the CAQH (Council for Affordable Quality Healthcare) ProView database.
  • Update the provider's NPI if necessary: Ensure that the provider's National Provider Identifier (NPI) is current, and make updates if required.
  • Verify Medical Licenses in Multiple States: Confirm the validity of provider medical licenses across various states, ensuring they meet all regulatory requirements.
  • Update Shared Drive for Manager: Keep the shared drive organized and up to date with the latest verified documents and information for managerial access.
  • Availity: Processed files via Availity for management as needed.

CUSTOMER SERVICE REPRESENTATIVE

Contractor with Everise at Humana
Orlando, FL
11.2020 - 05.2023
  • Contracted to work with Humana Insurance Company.
  • Resolved customer inquiries efficiently, maintaining high satisfaction levels.
  • Handled a high volume of customer calls with accuracy and professionalism.
  • Provided exceptional service, resulting in positive feedback, and repeat business.
  • Communicated with customers to ensure satisfaction with claim resolution.
  • Investigated and analyzed insurance policies to determine coverage for claims.
  • Processed and resolved claims accurately and efficiently for clients.
  • Processed invoices and handled billing inquiries for clients with accuracy and efficiency.
  • Resolved billing discrepancies and issues in a timely and professional manner.
  • Knowledge of CPT codes.
  • Data entry.
  • Managed high volumes of inbound calls with professionalism and efficiency.
  • Resolved customer complaints and inquiries promptly to ensure customer satisfaction.
  • Utilized strong communication skills to provide accurate information and support.

Bank Teller

Contractor with Alorica at USAA
Orlando, FL
03.2020 - 11.2020
  • Contracted to work with USAA Bank.
  • Proficient in processing deposits, withdrawals, and transfers accurately and efficiently.
  • Skilled at providing exceptional customer service, resolving issues, and promoting various banking products.
  • Experienced in handling large cash amounts, and maintaining adherence to security protocols.
  • Knowledgeable in using banking software and systems to carry out transactions effectively.
  • Provided excellent customer service and resolved issues promptly over the phone.
  • Demonstrated strong communication skills, and the ability to multitask in a fast-paced environment.
  • Met or exceeded performance metrics, such as call handle time, and customer satisfaction.

Hospitality Associate

Tanner Medical Center
Villa Rica, GA
07.2014 - 03.2018
  • Conducted comprehensive nutritional assessments for patients to develop personalized dietary plans.
  • Assisted dietitians in creating customized meal plans for patients.
  • Conducted dietary assessments and monitored patients' food intake.
  • Educated patients on proper nutrition and healthy eating habits.
  • Worked with the patients on setting their breakfast, lunch, and dinner menu during their stay according to the doctors' dietary restrictions.
  • I properly stocked my assigned floors with the needed necessities.
  • Worked in close collaboration with team members to ensure customers received high-quality service.

Education

HIGH SCHOOL DIPLOMA -

Huffman High School
01.2025

Business

Jefferson State Community College
Birmingham, AL

Skills

  • Microsoft software
  • Bookkeeping
  • Data entry
  • POS
  • Typing
  • Time management
  • Communication
  • Strategic Problem Resolution
  • Empathy
  • Multitasking
  • Research and analysis
  • Application assessments
  • Claims processing
  • Case management
  • Follow-up skills
  • Records maintenance
  • Empathic communication
  • Records management
  • Intake assessment
  • Client intake
  • Eligibility evaluation

Timeline

Member Service Representative

Contractor with OmniCare365 at UnitedHealthCare
11.2024 - Current

Intake Specialist

Peachgrove BC
01.2021 - Current

CUSTOMER SERVICE REPRESENTATIVE

Contractor with Everise at Humana
11.2020 - 05.2023

Bank Teller

Contractor with Alorica at USAA
03.2020 - 11.2020

Hospitality Associate

Tanner Medical Center
07.2014 - 03.2018

HIGH SCHOOL DIPLOMA -

Huffman High School

Business

Jefferson State Community College

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LaKiera Gaines-Clifton