Dedicated Customer Service professional with knowledge of service delivery and proven multitasking abilities. Committed to maintaining professional relationships to increase profitability and drive business results.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Customer Service Rep
John Hopkins Healthcare
Assist Medicare Advantage (MA) members and providers by compassionately handling call types from benefit eligibility, claims prior authorizations, enrollment pharmacy, DME etc
Address healthcare gaps by contacting members to discuss gaps recommended care for A1C, Diabetic Eye Examination, Colon cancer, Mammogram screenings
Communicate with members as main point of contact and resolve 99% issues with services including billing, premiums, benefits
Achieve 96% quality score resulting in first call resolution and positive feedback.
Customer Care Advocate Sr
United Healthcare
04.2021 - 03.2022
Led concierge and white-glove level service to 600+ assigned members by removing burdens and delivering end-to-end resolution
Serve as a single point of contact for the customer and form a strong relationship to support them
Own problem through to resolution on behalf of the member in real time or through comprehensive and timely follow-up with the member
Research complex issues across multiple databases and work with support resources to own the resolution of all customer issues and anticipate their future healthcare needs or potential opportunities to improve the experience
Utilize excellent organization skills to keep track of all follow-ups for my assigned member
Respond to and own consumer inquiries and issues
Conduct proactive research on assigned member accounts to identify service issues
Identify gaps in processes and work closely with other departments for process improvement
Educated members on previously submitted pre-authorizations or pre-determination requests
Meet the performance goals established for the position in the areas of efficiency, call quality, customer satisfaction, first call resolution, and attendance.
Patient Care Coordinator
United Healthcare
01.2019 - 03.2021
Connected patients with available community and charitable resources
Delivered excellent patient experiences and direct care
Upheld confidentiality requirements and regulatory compliance guidelines in all areas
Performed as subject matter expert for case management processes
Educated patients by explaining preparation instructions for upcoming procedures and tests
Encouraged patients to schedule recommended tests and procedures.
Clinical Care Coordinator
United Healthcare
09.2014 - 01.2019
Provided comprehensive administrative support to department staff
Assisted with patient scheduling and rescheduling, directing related billing issues to member services
Sustained high-level knowledge of federal and HIPPA regulations on patient privacy
Improved customer satisfaction scores through application of superior conflict resolution and problem-solving skills.
Contact Center Representative
State Employee Credit Union
09.2012 - 11.2013
Enhanced productivity by staying on top of call scripts and maintaining control over direction of conversations
Controlled customer calls effectively and efficiently in complex, fast-paced, and challenging call center environment
Answered over 50 calls per day to meet fast-paced call center demands
Met 90% customer service satisfaction ratings through quality control and productivity
Effectively led high-volume of inbound and outbound customer calls using great customer services skills
Performed various clerical duties by filing and faxing documents and creating customer databases.
Education
Bachelor of Science - Social Sciences
University of Maryland - University College
Hyattsville, MD
01.2020
Skills
Excellent verbal and communication
Call Management
Data Entry
Scheduling
Complaint Resolution
Medical terminology
Relationship Building
Candidates
Mariama Kamara, Paralegal, Enthusiastic customer service specialist eager to contribute to team success through hard work, attention to detail and excellent organizational skills. Clear understanding of resolving complex issues and winning customer loyalty. Motivated to learn, grow, and excel in the healthcare industry., 01/01/23, Current, Customer Service Rep, John Hopkins Healthcare, Assist Medicare Advantage (MA) members and providers by compassionately handling call types from benefit eligibility, claims prior authorizations, enrollment pharmacy, DME etc, Address healthcare gaps by contacting members to discuss gaps recommended care for A1C, Diabetic Eye Examination, Colon cancer, Mammogram screenings., Communicate with members as main point of contact and resolve 99% issues with services including billing, premiums, benefits., Achieve 96% quality score resulting in first call resolution and positive feedback., 04/01/21, 03/01/22, Customer Care Advocate Sr, United Healthcare, Led concierge and white-glove level service to 600+ assigned members by removing burdens and delivering end-to end resolution., Serve as a single point of contact for the customer and form a strong relationship to support them., Own problem through to resolution on behalf of the member in real time or through comprehensive and timely follow-up with the member, Research complex issues across multiple databases and work with support resources to own the resolution of all customer issues and anticipate their future healthcare needs or potential opportunities to improve the experience., Utilize excellent organization skills to keep track of all follow ups for my assigned member., Respond to and own consumer inquiries and issues., Conduct proactive research on assigned member accounts to identify service issues., Identify gaps in processes and work closely with other departments for process improvement., Educated members on previously submitted pre-authorizations or pre-determination requests., Meet the performance goals established for the position in the areas of efficiency, call quality, customer satisfaction, first call resolution and attendance, 01/01/19, 03/01/21, Patient Care Coordinator, United Healthcare, Connected patients with available community and charitable resources., Delivered excellent patient experiences and direct care Upheld confidentiality requirements and regulatory compliance guidelines in all areas., Performed as subject matter expert for case management processes Educated patients by explaining preparation instructions for upcoming procedures and tests., Encouraged patients to schedule recommended tests and procedures., 09/01/14, 01/01/19, Clinical Care Coordinator, United Healthcare, Provided comprehensive administrative support to department staff., Assisted with patient scheduling and rescheduling, directing related billing issues to member services., Sustained high-level knowledge of federal and HIPPA regulations on patient privacy., Improved customer satisfaction scores through application of superior conflict resolution and problem-solving skills, 09/01/12, 11/01/13, Contact Center Representative, State Employee Credit Union, Enhanced productivity by staying on top of call scripts and maintaining control over direction of conversations., Controlled customer calls effectively and efficiently in complex, fast-paced and challenging call center environment, Answered over 50 calls per day to meet fast-paced call center demands., Met 90% customer service satisfaction ratings through quality control and productivity., Effectively led high-volume of inbound and outbound customer calls using great customer services skills, Performed various clerical duties by filing and faxing documents and creating customer databases, 2020, Bachelor of Science, University of Maryland at Global Campus, Excellent verbal and written communication, Problem Analysis and Issue Resolution, Leadership, Medical terminology, Medicare/Medicaid, Health Insurance Portability and Accountability Act (HIPPA), Research, Howard County Maryland, 443 668 6025, Mseray2015@gmail.com
Robin Zupanc, Paralegal, State your career goals and show how they align with the job description you’re targeting. Be brief and keep it from sounding generic. Be yourself., 20XX, Current, Paralegal, The Phone Company, Summarize your key responsibilities and accomplishments. Where appropriate, use the language and words you find in the specific job description. Be concise, targeting 3-5 key areas., 20XX, 20XX, Paralegal, Trey Research, Summarize your key responsibilities and accomplishments. Here again, take any opportunity to use words you find in the job description. Be brief., 20XX, 20XX, Paralegal, Adatum Corporation, Summarize your key responsibilities and accomplishments. Where appropriate, use the language and words you find in the job description. Be concise, targeting 3-5 key areas., 20XX, 20XX, A.A. Paralegal Studies, Jasper University, Creativity, Leadership, Organization, Problem solving, Teamwork, 4567 Main Street, City, State, 98052, (718) 555–0100, robin@example.com
Certification
Accident, Health, Life, Variable annuities 01/2022
National Insurance Producer Registry
Clinical Quality Management Specialist- Utilization Management at JOHN HOPKINS HEALTH PLANSClinical Quality Management Specialist- Utilization Management at JOHN HOPKINS HEALTH PLANS