LoTeal Gainey
Lebanon,NJ
Summary
Experienced customer service professional with a strong background in fast-paced, customer-centric environments. Proven ability to consistently exceed service delivery goals. Exceptional skills in conflict resolution, process improvement, and ensuring customer satisfaction. Proficient in utilizing excellent communication skills to build and maintain strong client relationships. Seeking a challenging role to apply expertise in communication, benefits administration, and problem resolution to drive success.
Overview
19
19
years of professional experience
Work History
Member Service Advocate
Blue Cross Blue Shield of Massachusetts
Remote
07.2024 - Current
- Successfully handled intricate member concerns, maintaining positive customer relationships.
- Serve as primary liaison for building trusted member relationships.
- Initiated appeals procedures efficiently on all claims.
- Explained plan benefit designs in detail and addressed claims effectively through digital means.
- Handled in and outbound member inquiries through phone, mail, email, and chat.
- Assisted members in scheduling appointments, finding providers, and accessing care.
- Conducted outreach to identified members for health and wellness campaigns.
- Served as primary liaison with providers, Care Managers, and external vendors.
- Engaged and collaborated with healthcare providers to resolve member issues.
- Resolved barriers to care and addressed gaps in coverage to improve health outcomes.
- Promotes wellness programs and services to enhance care.
- Executed delegated duties as directed by management.
Customer Service Representative III
Conduent
Remote
03.2020 - 03.2024
- Streamlined the inquiry process, ensuring full accuracy in applications.
- Evaluated renewal details using a web-based platform.
- Documented absentee data within electronic system.
- Assessed NJ FamilyCare Medicaid eligibility by evaluating documentation and entering accurate data into a web-based system.
- Ensure accuracy of beneficiary information through verification.
- Initiate telephone calls to beneficiaries to follow up and confirm information, as necessary.
- Maintained excellence in meeting established performance metrics for customer interactions.
Community Support Advocate
connectRN
Remote
10.2021 - 01.2024
- Delivered seamless assistance to healthcare entities via chat, email, webforms, and telephone interactions.
- Resolved client-specific challenges to align with unique requirements.
- Managed and prioritized support tickets to ensure prompt resolutions.
- Executed active shift management to cover unfilled shifts for the day and pay period.
- Conducted regular monitoring of call-outs to ensure clients received necessary updates.
- Authorized payroll approval following client verification, alongside routine payroll processing.
- Assist with clinician credentials and non-clinical DNR’s
- Perform weekly outreach for VIP facilities
- Ensured timely client outreach by initiating contact during the initial 10-30 minutes of each shift for NCNS cases.
- Managed coverage for fluctuations in outreach needs during weekends.
- Ensured time-sensitive matters and critical items were promptly addressed across markets.
Assistant Manager
Ascena Retail Group
01.2009 - 01.2019
- Demonstrated exceptional leadership in the development and management of highly successful teams
- Successfully implemented innovative visual merchandising solutions that enhanced the overall presentation of products
- Achieved remarkable sales results by consistently exceeding sales goals, all while delivering top-notch customer service
Customer Service Representative
Consolidated Services Group
01.2017 - 01.2018
- Responded to customer inquiries, offering support for a range of services including precertification, network access, medical bill repricing, and Workers' Compensation First Report of Injury
- Proficiently utilized multiple databases to access essential information for callers and effectively collaborated with other departments to address inquiries
- Managed complex and time-sensitive calls
- Conducted rigorous quality assurance protocols as mandated to ensure service excellence and compliance
Customer Care Team Leader
Quidsi
01.2009 - 01.2011
- Demonstrated strong leadership and mentoring abilities by providing guidance and direction to a team of representatives
- Efficiently processed customer orders and inquiries, consistently managing an average of12 calls per day
- Effectively resolved escalated customer issues, ensuring strict adherence to the service philosophy and objectives of the organization
Senior Representative, Customer Relations
LexisNexis Martindale Hubbell
01.2006 - 01.2009
- Conducted in-depth analysis and implemented strategic solutions to mitigate and reduce financial losses
- Stepped into an interim managerial role, providing weekly management coverage as needed
- Played a pivotal role in the training and mentoring of new employees, contributing to their professional development and success
- Supervised and oversaw the resolution of escalated customer inquiries, ensuring swift and effective resolution
Education
Medical Assisting
AIMS Education College of Health Sciences
Piscataway, NJMedical Billing And Coding
Rutgers University
New Brunswick, NJSkills
- Empathy and active listening
- Conflict Resolution and Negotiation
- Time Management
- Adaptability
- Customer Relationship Management
- Data Entry and analytics
- Detail Driven
- Proficient use of remote CRM platforms
- Multitasking
- Data entry proficiency
- Strong interpersonal skills
Timeline
Member Service Advocate
Blue Cross Blue Shield of Massachusetts
07.2024 - Current
Community Support Advocate
connectRN
10.2021 - 01.2024
Customer Service Representative III
Conduent
03.2020 - 03.2024
Customer Service Representative
Consolidated Services Group
01.2017 - 01.2018
Assistant Manager
Ascena Retail Group
01.2009 - 01.2019
Customer Care Team Leader
Quidsi
01.2009 - 01.2011
Senior Representative, Customer Relations
LexisNexis Martindale Hubbell
01.2006 - 01.2009
Medical Assisting
AIMS Education College of Health Sciences
Medical Billing And Coding
Rutgers University