Latrice Sims
Ruskin
Summary
Personable and dedicated customer service representative with extensive experience in industry. Solid team player with upbeat, positive attitude and proven skill in establishing rapport with clients. Motivated to maintain customer satisfaction and contribute to company success. Articulate, enthusiastic and results-oriented with demonstrated passion for building relationships, cultivating partnerships and growing businesses.
Overview
15
15
years of professional experience
Work History
Customer Service Expert
T-Mobile
Tampa, FL
08.2025 - Current
- Utilized customer relationship management software to track interactions, ensuring accurate and timely follow-ups with clients.
- Provided exceptional customer support by resolving inquiries efficiently, enhancing customer satisfaction and loyalty.
- Developed and maintained strong relationships with customers, contributing to an increase in repeat business.
- Provided excellent customer service to resolve customer complaints in a timely manner as promised.
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service on each interaction with T-Mobile customers
Member Service Specialist
WellDyneRx
04.2022 - 08.2025
- Create or modify authorizations for medications.
- Make outbound calls if necessary while documenting the information.
- Answered telephones and provided information about order status, and pharmacy procedures.
- Greeted customers and responded to questions with friendly, knowledgeable assistance.
- Assisted pharmacy staff with preparing medications and filling orders.
- Communicated with patients to collect information about prescriptions and medical conditions or arrange consultations with pharmacists.
Claims Examiner
Aetna
03.2020 - 03.2022
- Review and adjudicate claims in accordance with claim processing guidelines
- Work directly with members, doctors and employer groups
- Analyzes and approves claims that cannot be auto adjudicated
- Submit Authorization request and Medical Necessity review
- Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and applies all cost containment measures to assist in the claim adjudication process
- Coordinates responses for routine phone inquiries and written correspondence related to claim processing issues
- Routes and triages complex claims to Senior Claim Benefits Specialist
- Utilizes all applicable system functions available ensuring accurate and timely claim processing service (i.e., utilizes Claim Check, reasonable and customary data, and other post-containment tools)
Appeals/Grievance Coordinator
General Dynamics
06.2013 - 03.2020
- Processing and or closing Grievance and appeals for providers and members
- Review, adjust and/or attaching authorizations when appropriate
- Creating and submitting subcases
- Resolving and closing appeals from the beginning to end
- Submit correspondence to providers as needed
- Handle expedited request
- Follow timely filing guidelines
- Strive to meet TAT for assigned appeals
- Highly educated in Medicare policies and guidelines
Customer Service Representative
Alorica
05.2011 - 06.2013
- Create or modify authorizations for medications.
- Make outbound calls if necessary while documenting the information.
- Answered telephones and provided information about order status, and pharmacy procedures.
- Greeted customers and responded to questions with friendly, knowledgeable assistance.
- Assisted pharmacy staff with preparing medications and filling orders.
- Communicated with patients to collect information about prescriptions and medical conditions or arrange consultations with pharmacists.
Education
High School -
Hillsborough High School
Tampa, FLSkills
- Typing 35 words per minute with 90% accuracy
- Basic computer skills
- Navigating various programs
- Using Microsoft Outlook
- Effective communication
- Articulating information
- Call center environment
- Multi-tasking
- Focus on tasks
- Data analysis
- Time management
- Coverage determination
- Microsoft office
Timeline
Customer Service Expert
T-Mobile
08.2025 - Current
Member Service Specialist
WellDyneRx
04.2022 - 08.2025
Claims Examiner
Aetna
03.2020 - 03.2022
Appeals/Grievance Coordinator
General Dynamics
06.2013 - 03.2020
Customer Service Representative
Alorica
05.2011 - 06.2013
High School -
Hillsborough High School