LaTonya Wilbourn

Tier 3 Customer Service Representative – Humana

• Manage complex member inquiries by handling enrollment, benefits, claims, and authorizations with accuracy and efficiency.
• Serve as a liaison between members, providers, and pharmacies, ensuring timely resolution of escalated issues.
• Process updates to member accounts, benefits, and coverage information while maintaining compliance with HIPAA and company policies.
• Provide detailed explanations of insurance benefits, billing, and claim statuses, enhancing member understanding and satisfaction.
• Collaborate with healthcare providers, doctors, and pharmacists to coordinate services and resolve authorization or medication concerns.
• Recognized for high call resolution rates, strong problem-solving, and empathetic customer support

• Respond to inbound calls from members regarding health plans, billing inquiries, payments, and insurance quotes.
• Ensure customer satisfaction by providing accurate information and professional support in a remote environment.
• Collaborate with internal teams to streamline support workflows, enhancing service efficiency and customer experience.

• Partnered with Walmart associates to pick and deliver grocery orders to customers promptly and accurately.
• Delivered personalized service that contributed to a 4.7-star customer satisfaction rating.
• Managed time effectively to ensure all deliveries met scheduled windows and customer expectations.

• Resolved customer issues related to billing, account updates, and service changes in a timely manner.
• Conducted follow-ups for dropped calls and accurately documented account information.
• Recommended service plans tailored to customer needs, improving satisfaction and retention.