Mary Hairston
Greensboro,NC
Summary
A highly focused individual with 20+ years of call and claim services experience. Demonstrates excellent problem solving and analytical skills. Works well independently, as a team player and collaborating with others. Possesses good verbal and written communication skills. Demonstrates the ability to effectively multitask in a fast-paced environment and meet deadlines. Strong ability to consult and communicate with internal/external constituents. Customer service Professional highly skilled in call center management, training, service solutions, and innovative marketing concepts.
Overview
24
24
years of professional experience
1
1
Certification
Work History
Senior Integrated Services Specialist
Aetna, A CVS Health Company
06.2023 - Current
- Oversee daily team workload, ensuring tasks are completed efficiently and accurately.
- Enhanced team productivity by streamlining processes and implementing time-saving strategies.
- Collaborated with cross-functional teams to achieve project goals on time.
- Collected, arranged, and input information into database system.
- Maintained database systems to track and analyze operational data.
- Generated reports detailing findings and recommendations.
- Evaluated staff performance and provided coaching to address inefficiencies.
Integrated Services Specialist
Aetna, A CVS Health Company
02.2022 - 06.2023
- Ensures collected reconciled dollars are allocated accurately to members in a timely manner
- Reviews monthly bills for accuracy before mailing out to members
- Run daily reports for review and assign to team for daily workload balance
- Handle escalated issues for the team via email, team chat and phone to resolve customer concerns accurately and timely
- Research customer inquiries and information by effectively using all available Policies and Procedures
- Train and mentor team members on various reports and work processes.
Risk Interviewer I
Quest Diagnostics - Part Time
03.2022 - 08.2022
- Answer Inbound Calls to verify applicants medical and personal history to apply for life insurance
- Make outbound calls to verify applicants medical and personal history to apply for life insurance.
Plan Coordination Consultant
Aetna
02.2018 - 02.2022
- Processes and coordinates all plan benefit changes and required structural and administrative updates into systems essential for on-line viewing, claim enrollment and billing purposes
- Analyzes and determines if products and services selected by customers are aligned with their benefit needs, and can be adequately supported by existing systems or operating platforms; additionally, seeks solutions and negotiates essential requirements in support of any non-standard plan selections
- Consults and communicates with internal constituents regarding the details associated with new business and revision activity in a timely manner and validates account structure
- Completes timely and accurate set-up of complex account structure and detailed benefit plans in systems for multiple constituents in order to satisfy both internal and external deadlines for production – impacting a wide variety products and services
- Reviews benefit provisions to ensure compliance with state and Federal legislative mandates; evaluation process may also include assessment of summary plan descriptions and other related documents prepared by the plan sponsor or third party
- Monitors and manages internal installation process and maintains case tracking tools to meet constituents expectations and business goals.
Customer Service Associate/Cashier
Kohl’s Department Store - Part Time
09.2018 - 12.2020
- Greet customers upon entering the store
- Train new hires on cash register
- Handle nightly closing procedures on registers and till count
- Handle customer transactions for purchase
- Handle customer service transactions such as returns and refunds
- Handle on-line store pick-ups
- Handle Amazon returns.
Analyst
Aetna
05.2010 - 02.2018
- Tracks initial requests and maintains status reports
- Supports projects by gathering and reviewing initial data
- Ensure data quality, consistency and conducts data audits
- Generates standard weekly/quarterly/monthly reports
- Communicates with internal constituents and may maintain or update information for internal constituent.
Healthcare Administrative Assistant
HOSPICE AND PALLIATIVE CARE - Clinicals/Lab
02.2017 - 03.2017
- Assisted with incoming referrals from physicians and facilities
- Scanned documents into ALLDOC application system
- Scheduled nursing assessment visits via EPIC system
- Pulled insurance verification from Medicare system.
Senior Customer Service Representative
Aetna
07.2004 - 05.2010
- Handle Network Mailbox Inquiries
- Train peers to handle network mailbox inquires
- Back Up Rework Reviewer
- Mann Supervisor Escalation Queue
- Research and analyze complex healthcare claims and lab data.
Customer Service Representative
Aetna
08.2000 - 07.2004
- Receive inbound calls to assist members with any benefit questions or concerns
- Send out any correspondence via fax, email, or US mail
- Schedule callbacks to ensure member/provider satisfaction.
Education
Associate of Applied Science in Health Information Management -
Kaplan University
04.2017
Office Administration -
Rockingham Community College
12.1992
High School Diploma -
Tunstall High School
06.1989
Skills
- Strong Microsoft Office Skills including, Word, Excel and Power Point
- Call Center Experienced in handling consumer calls and accounts
- Problem solving skills Strong ability to multitask, team player and great analytical skills
- Excellent verbal and written communication skills
- Expert Problem Solving
- Documentation Management
- Quality Assurance
- Root Cause Analysis
- Issue Research
- Audit reporting
Certification
- Completed Yellow Belt Training 2012 and 2016
- Completed White Belt Training 2016
Timeline
Senior Integrated Services Specialist
Aetna, A CVS Health Company
06.2023 - Current
Risk Interviewer I
Quest Diagnostics - Part Time
03.2022 - 08.2022
Integrated Services Specialist
Aetna, A CVS Health Company
02.2022 - 06.2023
Customer Service Associate/Cashier
Kohl’s Department Store - Part Time
09.2018 - 12.2020
Plan Coordination Consultant
Aetna
02.2018 - 02.2022
Healthcare Administrative Assistant
HOSPICE AND PALLIATIVE CARE - Clinicals/Lab
02.2017 - 03.2017
Analyst
Aetna
05.2010 - 02.2018
Senior Customer Service Representative
Aetna
07.2004 - 05.2010
Customer Service Representative
Aetna
08.2000 - 07.2004
Associate of Applied Science in Health Information Management -
Kaplan University
Office Administration -
Rockingham Community College
High School Diploma -
Tunstall High School
- Completed Yellow Belt Training 2012 and 2016
- Completed White Belt Training 2016
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