Lauren Kaapa
Healthcare Support Professional | Member Services & Training Candidate
Pooler,GA
Summary
Compassionate and performance-driven healthcare support professional with progressive experience across multiple Centene campaigns through ResultsCX. Dual-trained in Medicare and Medicaid, with specialized knowledge of Fidelis Care, Ambetter, and WellCare products including Essential Plan (EP), HARP, CHP, HBX, and Medicare Advantage. Skilled in member services, prior authorizations, pharmacy, dental, and vision support, crisis call handling, and multi-system escalation. Trained on over a dozen platforms including Salesforce, Medhok, ESI Portal, Evernorth, CareConnects, ePACES, CCA, DataNet, Payspan, 834 Enrollment Search, Member Wiki, and more. Promoted to the Fidelis campaign as 1 of only 15 selected out of 100 agents based on performance and attendance. Currently pursuing a B.A. in Psychology (Graduation: June 2026), with a focus on behavioral health and healthcare services.
Overview
10
10
years of professional experience
2027
2027
years of post-secondary education
6
6
Certifications
Work History
Main Line Member Services Agent – Fidelis Care Campaign
ResultsCX / Centene
02.2025 - Current
- Handle complex inquiries across Medicaid, Ambetter, Essential Plans, CHP, HARP, HBX, and more.
- Provide support for claims, denials, appeals, prior authorizations, and personal care services.
- Assist members with pharmacy benefits, dental/vision (DentaQuest, Davis Vision), and member updates.
- Escalate to appropriate departments for advanced resolution; manage high-emotion/crisis calls with empathy.
- Use systems including Salesforce, Medhok, ESI Portal, Member Wiki, Payspan, 834 Enrollment, ePACES, CCA, and DataNet.
Medicare Member Services Representative (Training) – WellCare Campaign
ResultsCX / Centene
12.2024 - 02.2025
- Completed Centene-certified training to support Medicare Advantage members with claims, benefits, enrollments, and plan use.
- Developed expertise in Medicare Parts A, B, C, and D and compliance with CMS guidelines.
- Assisted members during live call scenarios with prior authorizations, spendable card transactions, and referral inquiries.
- Used systems including Solutran, CareConnects, Evernorth, Salesforce, and Confluence.
- Prepared for internal transition to Fidelis campaign through strong performance and engagement.
Outbound Sales Agent (Non-Licensed, MADP) – WellCare Campaign
ResultsCX / Centene
08.2024 - 12.2024
- Conducted outbound calls and real-time chats to guide members through Medicare plan options.
- Used Scripter, Avaya Agent, Altitude, and Salesforce to triage and route callers.
- Verified member eligibility and provided assistance with starting or renewing coverage.
- Recorded detailed member interactions and coordinated with departments via Teams and Outlook.
- Briefly cross-trained on inbound non-licensed pre-enrollment workflows to support team flexibility during peak periods.
Office Supervisor
Josh Collins Heating & Air
01.2016 - 01.2022
- Supervised daily office operations, ensuring efficient workflow and adherence to company policies.
- Handled over 40 daily calls, billing, customer escalations, and QuickBooks invoicing.
- Managed customer communications and seasonal workflow planning.
- Hired, managed, developed and trained staff, established and monitored goals, conducted performance reviews.
- Developed training materials for onboarding procedures, improving new hire integration into the team.
Education
Bachelor of Arts - Psychology
Southern New Hampshire University
Manchester, NH06-2026
Skills
- Medicaid & Medicare Member Support (CHP, HARP, HBX, EP, MA)
- Claims, Denials, Pharmacy & Prior Authorization Resolution
- Inbound & Outbound Member Services (Pre/Post Enrollment)
- Crisis Call De-escalation & HIPAA/PHI Compliance
- Centene Systems & Tools: Salesforce, Medhok, ESI Portal, CareConnects, Evernorth, ePACES, CCA, DataNet, Payspan
- Phone & CRM Tools: Avaya Workplace, Avaya One-X, InGenius, Scripter, Altitude
- System Navigation & Troubleshooting: Citrix, Centene Remote Desktop, Avaya Tools, ResultsCX Applications
- Dental/Vision Support: DentaQuest, Davis Vision
Certification
Medicare Parts A, B, C, D & Medicare Advantage Trained (WellCare)
Remote Ready
True
Timeline
Main Line Member Services Agent – Fidelis Care Campaign
ResultsCX / Centene
02.2025 - Current
Medicare Member Services Representative (Training) – WellCare Campaign
ResultsCX / Centene
12.2024 - 02.2025
Outbound Sales Agent (Non-Licensed, MADP) – WellCare Campaign
ResultsCX / Centene
08.2024 - 12.2024
Office Supervisor
Josh Collins Heating & Air
01.2016 - 01.2022
Bachelor of Arts - Psychology
Southern New Hampshire University
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