Octavia Jones
Summary
Customer Service Representative with 3+ years of experience supporting healthcare providers and members in fast-paced call center environments. Skilled in provider relations, claims research, eligibility verification, HIPAA compliance, and resolving complex inquiries. Proven ability to meet performance metrics, maintain accurate documentation, deliver exceptional customer service in both onsite and remote settings.
Overview
4
4
years of professional experience
4
4
years of post-secondary education
Work History
CSR - Customer Service Representative
Metroplus Health
New York
09.2024 - 03.2026
- Managed inbound and outbound provider communications, ensuring timely resolution of inquiries and enhancing provider satisfaction
- Resolve on average of 50 provider issues daily regarding claims, referrals and authorizations while consistently meeting performance metrics
- Addressed complex questions regarding eligibility, benefits, and coverage, documenting all interactions in CRM systems for HIPAA compliance and audit readiness
- Researched claims, verified eligibility, and maintained provider/member records using Salesforce, eMedNY, and ePACES with high accuracy
Customer Service Representative
Maximus Health Services
New York
03.2023 - 09.2024
- Updated knowledge of New York Medicaid Choice Project to deliver accurate information to callers
- Assisted Call Center Operations and other departments as directed by project management to achieve business objectives
- Escalated calls or issues to designated staff for resolution, facilitating prompt and effective problem-solving
- Supported Call Center Operations and other departments as determined by project management, contributing to overall business objectives
Activity Specialist
Sheltering Arms Children and Family Services, Inc.
New York
05.2022 - 05.2023
- Designed and led programs nationally and in Germany to facilitate software use in mathematics and science instruction, enhancing learning outcomes
- Coordinated communications, material acquisition, and equipment setup for contract instructor-led classes, ensuring seamless delivery
- Directed group activities to enhance group interaction behavior and teamwork, promoting effective interpersonal communication and positive dynamics
Education
High School Diploma - Upper secondary education
Satellite Academy High School
New York, USA 09.2000 - 06.2004
Skills
- Customer service
- Client Engagement
- Claims resolution
- Eligibility Verification
- Healthcare programs
- HIPAA Compliance
- Healthcare Systems
- CRM Software
- Data Entry & Documentation
- Microsoft Office
- Call Management
- Service Quality
- Problem Solving & Conflict Resolution
- Remote Work Experience
Languages
English
Timeline
CSR - Customer Service Representative
Metroplus Health
09.2024 - 03.2026
Customer Service Representative
Maximus Health Services
03.2023 - 09.2024
Activity Specialist
Sheltering Arms Children and Family Services, Inc.
05.2022 - 05.2023
High School Diploma - Upper secondary education
Satellite Academy High School
09.2000 - 06.2004