Summary
Overview
Work History
Skills
Certification
Timeline
Generic

Michelle Cameron

Ewa Beach,United States

Summary

Dedicated Quality Specialist with extensive experience utilizing auditing tools and assessing agent performance in a healthcare contact center environment. Skilled in identifying process improvements, ensuring compliance with quality standards, and contributing to overall service efficiency. Eager to transition into a Trainer I role, bringing a strong understanding of call center operations, performance evaluation, and the ability to collaborate across teams to enhance employee development.

Overview

6
6
years of professional experience
1
1
Certification

Work History

Quality Assurance Speciliast II

Centene Corporation
08.2022 - Current
  • Utilize comprehensive quality monitoring tools to evaluate the performance of call center agents, ensuring adherence to policies and procedures. Conduct detailed audits of inbound and outbound calls, identifying areas for improvement and ensuring consistent compliance with quality standards.
  • Conduct detailed audits of inbound and outbound calls, identifying areas for improvement and ensuring consistent compliance with quality standards.
  • Collaborate with team leaders to provide feedback on agent performance and identify areas where additional support or development may be required.
  • Analyze and audit work performance data to recommend process improvements that enhance efficiency, improve training results, and metrics.
  • Contribute to refining and improving the auditing tools used to assess agent performance, ensuring accurate and consistent evaluations, and evaluate the effectiveness and clarity of work processes and procedures.

Claims Liaison I / Provider Resolution Specialist

Centene Corporation
11.2020 - 07.2022
  • Reviewed escalated claims and made necessary adjustments for payments or upheld denials, ensuring adherence to policy guidelines, and improving claim resolution accuracy.
  • Collaborated with Customer Service Representatives (CSRs) and other internal departments to resolve complex claims issues, providing detailed feedback to enhance understanding of claims processing. Assist with revisions to policy and procedures and/or work process development
  • Delivered insights and suggestions to improve claims handling processes, contributing to overall efficiency and service quality.
  • Facilitated the communication of process updates and clarification of policies, helping internal teams stay informed and ensuring consistency in claims management.
  • Supported process improvement initiatives by analyzing claims data and recommending adjustments to streamline workflows.
  • Recommended training needs and suggestions to improve claims handling processes, contributing to overall efficiency and service quality.

Customer Service Representative

WellCare Health Plans Inc.
05.2019 - 10.2019
  • Resolved complex member and provider inquiries related to claims, eligibility, and benefits, ensuring first-call resolution and high levels of customer satisfaction.
  • Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
  • Developed strong product knowledge to provide informed recommendations based on individual customer needs.


Customer Service Representative (Temp)

WellCare Health Plans Inc.
08.2018 - 04.2019

Skills

  • Auditing Tools Utilization
  • Performance Evaluation
  • Quality Monitoring & Reporting
  • Process Improvement
  • Policy & Procedure Adherence
  • Cross-functional Collaboration
  • Compliance & Standards Enforcement
  • Call Center Operations

Certification

  • Quality Management Foundations, 2020
  • Quality Management for Operational Excellence, 2020
  • Customer Service Foundations, 2020
  • Creating a Positive Customer Experience, 2017
  • Customer Service Mastery: Delight Every Customer, 2017

Timeline

Quality Assurance Speciliast II

Centene Corporation
08.2022 - Current

Claims Liaison I / Provider Resolution Specialist

Centene Corporation
11.2020 - 07.2022

Customer Service Representative

WellCare Health Plans Inc.
05.2019 - 10.2019

Customer Service Representative (Temp)

WellCare Health Plans Inc.
08.2018 - 04.2019
Michelle Cameron