MELANIE C. MCCLINTON
GA
Summary
Result-oriented individual seeking a position where polished relational skills, multitasking skills, and ability to navigate through complex and sensitive situations to resolution will be utilized.
Overview
9
9
years of professional experience
Work History
Member Retention Specialist
KAISER PERMANENTE
11.2022 - Current
- Ensure resolution and follow up on member complaints and administrative appeals
- Receive and handle complaints from Program Office, Medical Director, President, Regulatory Agencies, State and Federal departments (except for Insurance Advocate), and Internet
- Ensure complaints and administrative appeals are handled according to department and regulatory guidelines
- Maintain up-to-date understanding of Health Plan benefits and delivery system
- Establish relationships and maintain regular contact with key individuals in the medical facilities, affiliated community physician and external consultant practices, and administrative departments
- Demonstrate excellence in oral and written communications
Resolution Specialist
KAISER PERMANENTE
02.2019 - Current
- Responds and resolves all escalated issues ensuring first call resolution
- Ensures the timely intervention of member issues to enhance member satisfaction and member recruitment/retention
- Ensure best practice customer service while maximizing revenue
- Completes work assignments by applying up-to-date knowledge in subject area to meet deadlines
- Work with external partners collaboratively to respond to and resolve escalated and complex issues
- Demonstrates good judgment in selecting methods and techniques for obtaining solutions
- Deliver presentations to management and team during huddles and team meetings
- Performs intermediate spreadsheet analyses using tools such as Excel
- Researches and responds to inquiries from business units and stakeholders
- Analyze data and trends
- Works closely with key stakeholders
- Pursues self-development and effective relationship with others by sharing resources, information, and knowledge with customers and coworkers
- Partners with KP departments, sales & marketing, customers and other stakeholders to provide SME knowledge to address member concerns or support projects
- Assists with project activities related to organizational change management as defined by the project
- Supports the compliance of project plans by following policies and procedures
- Provides ongoing support to project personnel by regularly communicating with project team members to ensure schedule data and changes are accurately interpreted and accounted for
- Provides real-time updates to Managers regarding scheduling conflicts
- Provide standard reports on a regular or as needed basis
- Measures and monitors service performance quality standards to ensure customer satisfaction and to comply with regulatory agencies
- Assist with recruiting process and interviewing process
Health Plan Service Specialist
KAISER PERMANENTE
07.2018 - 02.2019
- Responsible for intake and resolution of complaint/grievance cases
- Responds and resolves escalated issues ensuring first call resolution
- Assist CSR's with complex problems and questions
- Coach and mentor employees based on feedback received through the call monitoring process
- Conduct quality call monitoring reviews and provide timely feedback
- Subject Matter Expert; Assist management with post classroom training for new hires
Customer Service Representative
KAISER PERMANENTE
11.2016 - 07.2018
- Answer and document all incoming contacts to determine their nature while delivering quality phone service to ensure high standards are maintained
- Respond to complex calls related to specialized product lines or queues
- Responsible for intake of complaint and grievance questions
- Assist management with providing feedback and coaching to CSRs
- Initiate contact with appropriate health plan, medical group and facility personnel to obtain information relevant to the members concern or inquire as needed
- Subject Matter Expert; Assist management with post classroom training for new hires
Assistant Community Manager
BELL PARTNERS
02.2016 - 08.2016
- Assist Community Manager with daily functions of office staff, post rental collections, make bank deposits and oversee the administration of accounting functions for the community
- Maintain resident lease files and computer records for community
- Process notices to vacate & manage delinquency/file evictions as necessary
- Support leasing consultants in the leasing of apartments and ensure that Fair Housing guidelines are followed; verify potential resident applications
- Calculate daily, weekly and monthly reporting structure to assure goals are met
- Uses professional concepts and company policies and procedures to solve a wide range of difficult problems in imaginative and practical ways
Education
High School Diploma -
D.M. Therrell High School
Bachelor of Arts - Healthcare Administration - In Progress
University of Phoenix
Tempe, AZSkills
- Customer service
- Management
- Leadership
- Healthcare
- Marketing
- Written communication
- Oral communication
- Microsoft Office Suite
- Problem-solving
- Interpersonal skills
- Customer Service Model
- Hot Alerts Survey
- National Huddles Project
- Road Runner
- Chat Captain
Personalemail
MELANIE.MCCLINTON@YAHOO.COM
Timeline
Member Retention Specialist
KAISER PERMANENTE
11.2022 - Current
Resolution Specialist
KAISER PERMANENTE
02.2019 - Current
Health Plan Service Specialist
KAISER PERMANENTE
07.2018 - 02.2019
Customer Service Representative
KAISER PERMANENTE
11.2016 - 07.2018
Assistant Community Manager
BELL PARTNERS
02.2016 - 08.2016
High School Diploma -
D.M. Therrell High School
Bachelor of Arts - Healthcare Administration - In Progress
University of Phoenix
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