Maleka Lumar
Laplace,LA
Summary
To obtain a position within an organization; which will utilize my proven customer service skills, and offer a unique experience in a challenging environment.
Overview
12
12
years of professional experience
Work History
Senior Complex Customer Care Representative
UNITEDHEALTHCARE/CARE MANAGEMENT OPERATIONS
01.2025 - Current
- Build and maintain strong relationships to provide premium level service, removing burdens and providing end-to-end resolution for members, this includes Clinical, Financial Decision Support, and Claims inquiries.
- Answer up to 30 to 60 incoming calls, emails and chats per day from members of our health and pharmacy plans
- Contact care providers (doctor’s offices) on behalf of the customer to assist with billing and go over benefits.
- Demonstrate expertise in claims processing and interpretation, resolving any claim-related issues.
- Identify the areas of assistance and offer resolution for benefits and self-service options.
- Assist in navigating company websites or applications utilizing remote desktop system capabilities
- Research complex issues across multiple databases and work with support resources to resolve member issues.
- Meet the performance goals established for the position in the following areas: effectiveness, efficiency, call quality, member satisfaction, first call resolution, and adherence.
Senior Customer Service Representative
UNITEDHEALTHCAREGROUP/QUEST DIAGNOSTICS
10.2023 - 01.2025
- Researched complex issues across multiple databases and work with support resources to resolve customer issues.
- Intervened with care providers (doctor’s offices) on behalf of the customer to assist with billing inquiries.
- Answered incoming phone calls (50-70 calls a day) from patients/doctor’s offices and identify the type of assistance the customer needs.
- Evaluated EOBs (explanation of benefits) from insurance companies and patients for potential adjustments on bills
- Set up payment arrangements and/or financial assistance applications for qualified patients
- Set up appointments for patients to go into our Questfor labs to be performed.
Clinical Administrator Coordinator
UNITEDHEALTHCARE GROUP/PEOPLES HEALTH NETWORK
12.2020 - 10.2023
- Welcomed and greet members and guests in a professional manner
- Answered, direct, and document incoming phone calls
- Provided education and clarification on the H.I.P.A.A. and Consents to Treat documents
- Obtained electronic signature or scan necessary documents, such as consent form and Compressive Wellness Checklist.
- Assisted members with scheduling appointments.
- Placed outbound telephone calls to confirm same-day and/or no-show appointments.
- Ensured that all schedules are closed at the end of the day with no pending appointments.
- Met or exceed established production metrics for outbound telephone call volumes
- Reviewed and updates member demographics (address, telephone numbers, etc. in the electronic medical record)
- Traveled to other service centers for coverage as needed
Inbound Contact Representative 2/Team Lead
HUMANA
09.2019 - 12.2020
- Addressed customer needs which may include complex benefit questions, resolve issues, and educated members.
- Recorded details of inquiries, comment or complaints, transactions or interactions.
- Performed as a Team Lead; delegated daily/weekly/monthly reports out to the team; provided coaching and feedback to the team in supervisors’ absence, took complaint supervisor calls; helped and delegated meetings with the supervisor, and helped conduct interviews for hiring.
- Worked on special projects as needed.
TPA Administrator Account Advisor 2
Blue Cross and Blue Shield of Louisiana
Baton Rouge, LA
06.2014 - 03.2018
- Assisted members and providers with online access to view their benefits and providers with online access to view their benefits ad claims information.
- Handled incoming calls to educate providers and members regarding benefits, claims, authorizations, and appeals information.
- Researched appeals on claims and authorizations for members and providers.
- Assisted with typing correspondence letters that are requested from providers and members.
- Reinforced policy and procedures to incoming calls with providers and members.
- Routed tasks to other departments within the organization to get resolutions on issues for providers and members.
- Handled supervisor callbacks to members and providers
- Assisted with doctors, nurses, and other clinic and hospital personnel.
Education
Associates Degree - Business Management, Human Resource Management
DELGADO COMMUNITY COLLEGE
Skills
- Microsoft Office Suite
- Data Entry
- Customer Service Specialist
- Complaint handling
- Relationship building
- Customer relations
- Payment processing
- Problem resolution
- First call resolution
Timeline
Senior Complex Customer Care Representative
UNITEDHEALTHCARE/CARE MANAGEMENT OPERATIONS
01.2025 - Current
Senior Customer Service Representative
UNITEDHEALTHCAREGROUP/QUEST DIAGNOSTICS
10.2023 - 01.2025
Clinical Administrator Coordinator
UNITEDHEALTHCARE GROUP/PEOPLES HEALTH NETWORK
12.2020 - 10.2023
Inbound Contact Representative 2/Team Lead
HUMANA
09.2019 - 12.2020
TPA Administrator Account Advisor 2
Blue Cross and Blue Shield of Louisiana
06.2014 - 03.2018
Associates Degree - Business Management, Human Resource Management
DELGADO COMMUNITY COLLEGE