RALPH POMAIBA
Fairmont,WV
Summary
Experienced C&S Navigator Advocate4Me Rep Sr, eager to contribute skills and expertise to UHG. Proficient in UHC M&R businesses and C&S Medicaid with a proven track record of issue resolution and meeting member needs. Motivated self-starter with excellent communication and computer skills, further strengthened through leadership experience as a Mentor/Team Lead/SME. Dedication as a Member Representative is unwavering, striving to provide top-notch support by delivering accurate information on insurance coverage, finance options, and documentation requirements. Strong background in scheduling and database management for efficient communication and reduced backlogs. Enhance engagement strategies and overall service by identifying member needs and concerns. Demonstrated commitment to efficiency and member advocacy while maintaining professionalism in high-pressure situations throughout 9 years of healthcare experience.
Overview
9
9
years of professional experience
1
1
Certification
Work History
M&R Navigator
United Healthcare, UHG
01.2025 - Current
- Followed up with customers about resolved issues to maintain high standards of customer service.
- Responded proactively and positively to rapid change.
- Delivered exceptional customer service to every customer by leveraging extensive knowledge of products and services and creating welcoming, positive experiences.
- Identified and resolved discrepancies and errors in customer accounts.
- Delivered prompt service to prioritize customer needs.
- Investigated and resolved customer inquiries and complaints quickly.
- Reduced process inconsistencies and effectively trained team members on best practices and protocols.
- Enhanced productivity levels by anticipating needs and delivering outstanding support.
- Responded to customer requests, offering excellent support and tailored recommendations to address needs.
- Sought ways to improve processes and services provided.
- Maintained up-to-date knowledge of product and service changes.
- Educated customers about billing, payment processing and support policies and procedures.
- Met customer call guidelines for service levels, handle time and productivity.
- Increased efficiency and team productivity by promoting operational best practices.
- Maintained confidential patient, employee and company information in compliance with company policies and regulatory requirements.
- Gathered information, assessed and fulfilled callers' needs and educated on important policies and procedures.
- Stayed calm under pressure to and successfully dealt with difficult situations.
C&S Navigator Advocate4Me Rep Sr
United Health Group
11.2021 - 12.2024
- Advocate for clients or patients to assist during health events
- Utilize consultation data and work experience to help plan and coordinate member care and rehabilitation, following through to ensure service efficacy
- Monitor and record members progress to ensure that goals and objectives are met
- Prepare and maintain records and case files, including documentation such as member personal and eligibility information, services provided, narratives of member contacts, and relevant correspondence
- During my current role, I have also been a SME for training classes for new Vendors as part of the POET program and I assisted my team in chat as well as meetings with questions and became NPS Champion and M&R Certified Level 2
- Followed up with customers about resolved issues to maintain high standards of customer service.
- Responded proactively and positively to rapid change.
- Delivered exceptional customer service to every customer by leveraging extensive knowledge of products and services and creating welcoming, positive experiences.
- Identified and resolved discrepancies and errors in customer accounts.
- Investigated and resolved customer inquiries and complaints quickly.
UHC DCC Mentor
Teleperformance
07.2021 - 10.2021
- Answered inquiries and addressed, resolved or escalated issues to management personnel to ensure client satisfaction
- Provided one-on-one support
- Ensured superior customer experience by assisting agents in addressing member concerns, demonstrating empathy and resolving problems on the spot
- Collaborated with staff members to enhance customer service experience and exceed team goals through effective client satisfaction rates.
- Met customer call guidelines for service levels, handle time and productivity.
- Maintained up-to-date knowledge of product and service changes.
- Responded to all agent inquiries thoroughly and professionally
- Increased efficiency and performance by monitoring team member productivity and providing feedback.
- Increased efficiency and team productivity by promoting operational best practices.
UHC N4ME Mentor
Teleperformance
02.2020 - 06.2021
- Worked directly with N4ME agents to achieve resolutions for members
- Answered inquiries and addressed, resolved or escalated issues to management personnel to ensure client satisfaction
- Provided one-on-one support
- Ensured superior customer experience by assisting agents addressing member concerns, demonstrating empathy and resolving problems on the spot
- Responded to all agent inquiries thoroughly and professionally
UHC N4ME Service Navigator Service Account Manager
Teleperformance
06.2019 - 02.2020
- Advocate for clients or patients to assist during health events
- Utilize consultation data and work experience to help plan and coordinate member care and rehabilitation, following through to ensure service efficacy
- Monitor and record members progress to ensure that goals and objectives are met
- Prepare and maintain records and case files, including documentation such as member personal and eligibility information, services provided, narratives of member contacts, and relevant correspondence
UHC MA East Mentor
Teleperformance
03.2018 - 06.2019
- Answered inquiries and addressed, resolved or escalated issues to management personnel to ensure client satisfaction
- Provided one-on-one support
- Ensured superior customer experience by assisting agents addressing member concerns, demonstrating empathy and resolving problems on the spot
- Responded to all agent inquiries thoroughly and professionally
- Received the 'Blue Diamond' award back to back during time as a mentor
UHC MA East Agent
Teleperformance
02.2018 - 03.2018
- Assisted members with different issues such as claims, billing, benefits and setting appointments
- Recipient of multiple positive reviews acknowledging dedication to excellent customer service
- Developed reputation as an efficient service provider with high levels of accuracy
UHC MA East Mentor
Teleperformance
08.2017 - 02.2018
- Answered inquiries and addressed, resolved or escalated issues to management personnel to ensure client satisfaction
- Provided one-on-one support
- Ensured superior customer experience by assisting agents addressing member concerns, demonstrating empathy and resolving problems on the spot
- Responded to all agent inquiries thoroughly and professionally
UHC MA East Agent
Teleperformance
04.2017 - 08.2017
- Recipient of multiple positive reviews acknowledging dedication to excellent customer service
- Developed reputation as an efficient service provider with high levels of accuracy
- Ensured superior customer experience by assisting agents addressing member concerns, demonstrating empathy and resolving problems on the spot
- Responded to all agent inquiries thoroughly and professionally
- Customer Service Consistently received positive feedback from members
UHC RSS Agent
Teleperformance
01.2017 - 04.2017
- Worked directly with Tier 1 agents to achieve resolutions for members
UHC MA East Agent
Teleperformance
11.2015 - 01.2017
- Assisted members with different issues such as claims, billing, benefits and setting appointments
- Recipient of multiple positive reviews acknowledging dedication to excellent customer service
- Developed reputation as an efficient service provider with high levels of accuracy
Education
High school or equivalent - General Education
COATESVILLE AREA SENIOR HIGH SCHOOL
Coatesville, Pa01.1993
Skills
- Customer Service
- Claims
- Billing
- Excellent Customer Service
- Leadership
- Mentoring
- Follow-up skills
- Stress tolerance
- Insurance verification
- HIPAA compliance
- Medical terminology
- Record maintenance
- Claims processing
- Policy adherence
- Patient confidentiality
- Medical billing
- Call center experience
- Appointment scheduling
- Customer service
- Insurance company billing
- Post-discharge care coordination
- Customer follow-up
- Training coordination
- Formularies
- Insurance billing
- Team collaboration
- Quality assurance
- Multitasking and organization
- Conflict resolution
- Relationship building
- Verbal and written communication
- Team leadership
- Information collection
- Phone and email etiquette
- Data entry
- Friendly and outgoing
- Electronic health records
Certification
- M&R Certified, United Healthcare
Timeline
M&R Navigator
United Healthcare, UHG
01.2025 - Current
C&S Navigator Advocate4Me Rep Sr
United Health Group
11.2021 - 12.2024
UHC DCC Mentor
Teleperformance
07.2021 - 10.2021
UHC N4ME Mentor
Teleperformance
02.2020 - 06.2021
UHC N4ME Service Navigator Service Account Manager
Teleperformance
06.2019 - 02.2020
UHC MA East Mentor
Teleperformance
03.2018 - 06.2019
UHC MA East Agent
Teleperformance
02.2018 - 03.2018
UHC MA East Mentor
Teleperformance
08.2017 - 02.2018
UHC MA East Agent
Teleperformance
04.2017 - 08.2017
UHC RSS Agent
Teleperformance
01.2017 - 04.2017
UHC MA East Agent
Teleperformance
11.2015 - 01.2017
- M&R Certified, United Healthcare
High school or equivalent - General Education
COATESVILLE AREA SENIOR HIGH SCHOOL
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