Regina Jones
Taylor,MI
Summary
Highly skilled Senior Customer Service Advocate with over 10 years of experience in delivering exceptional service and support across diverse industries. Known for a strong ability to resolve complex issues, manage high-volume inquiries, and enhance customer satisfaction through effective communication and problem-solving. Adept at training and mentoring teams, fostering a collaborative environment, and ensuring seamless service delivery. Proven track record of consistently meeting and exceeding performance metrics, with a focus on efficiency, accuracy, and customer retention. Strong interpersonal skills combined with a deep understanding of customer needs, enabling the development of long-lasting relationships and continuous improvement in service processes.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Customer Service Advocate II
Centene, Meridian Health Plan of MI
03.2021 - Current
- Efficiently manage a high volume of inbound calls from members and providers, delivering prompt and accurate assistance on medicaid claims, prior authorizations, billing, covered benefits, and eligibility inquiries.
- Ensure exceptional service and provide first call resolutions by addressing concerns and working with appropriate internal/external resources to provide clear guidance and ensure closure of all inquiries while adhering to regulatory and organizational standards.
- Research and identify processing inaccuracies in claim payments, prior authorization submissions, and member and provider eligibility and route to the appropriate team for adjustments.
- Proactively monitor policy updates, procedural changes, and system enhancements to ensure compliance and efficiency which allow me to provide accurate and timely information to members and providers.
- Skilled in researching, interpreting and communicating complex information clearly and effectively.
- Assist members and providers with portal registration, navigation, and technical support, ensuring seamless access to online resources.
- Consistently meet or exceed established performance metrics by maintaining a high standard of accuracy, efficiency, and service quality.
- Support job shadowing and nesting of new hires, providing guidance and support to ensure a smooth transition into their roles.
- Provide continuous support by addressing teammates inquiries via chat, fostering collaboration and knowledge sharing to enhance team efficiency and performance.
- Recognized for excellence in training new hires and fostering a supportive learning environment, ensuring new employees gain the knowledge and confidence needed for success.
Customer Service Representative
R1 Rcm
10.2018 - 11.2020
- Assisted in resolving provider claim inquiries by delivering clear and detailed explanations regarding claim denials, including the reasons for non-payment and actionable steps for claim resolution and reimbursement.
- Handled 80 to 100 inbound calls daily from patients and providers, providing prompt and accurate assistance with referral inquiries and concerns while ensuring a high level of customer service satisfaction.
- Accurately updated patients accounts as needed, including demographics, insurance details, HIPAA authorizations, medical changes, and billing information ensuring data integrity and compliance with regulatory standards.
- Provided expert assistance to patients in understanding their medical claims and Explanation of Benefits and offering clear guidance on coverage, billing details and claim statuses.
- Ensured patient had a comprehensive understanding of their benefits and financial responsibilities while addressing any concerns with professionalism and accuracy.
- Provided exceptional training programs for multiple new hires simultaneously and implementing engaging training sessions that enhance team performance, productivity and skill development.
- Consistently met and exceeded all established performance metrics, demonstrating a high level of dedication, efficiency, and effectiveness in my role. My commitment to excellence has been recognized by both peers and leadership, resulting in multiple awards and acknowledgments for my outstanding contributions. These recognitions highlight my ability to deliver superior results, maintain a strong work ethic, and contribute meaningfully to team and organizational goals. My consistent performance underscores my adaptability, attention to detail, and proactive approach in achieving success.
- Recognized with "Employee of the Month" awards on multiple occasions for consistently demonstrating exceptional performance, dedication, and contribution to team success.
Production Operator
FCA Trenton Engine
04.2018 - 09.2018
- Demonstrated ability to read and understand specifications and work them according to instructions given.
- Documented production information via daily system logs and discussed issues with management.
- Participated in training sessions to enhance skills and knowledge.
- Used equipment properly to avoid workplace hazards or injuries.
Customer Support Representative/Senior Data Entry Specialist
Auto Club Group AAA
10.2012 - 04.2018
- Responsible for processing a wide range of membership and auto insurance-related transactions, including enrollments, auto and home applications, payments, policy corrections, cancellations, and the handling of various documents necessary for issuing or endorsing memberships and insurance products.
- Ensuring accuracy and efficiency in processing each request, maintaining compliance with relevant policies and regulations, and delivering a seamless experience for both internal teams and clients.
- Managed daily incoming calls and emails from sales representatives addressing inquiries related to ratings, premiums, billing issues, cancellations, and procedural matters. Provided support to agents in resolving complex processing issues, ensuring efficient and effective solutions while maintaining high standards of customer service.
- Responsible for obtaining and verifying payments, along with other essential information, to ensure the accurate processing and servicing of membership and insurance accounts. This involved meticulous attention to detail and adherence to established protocols, ensuring the integrity of account data and facilitating seamless transaction processing.
- Drafted and sent formal correspondence to agents and members, documenting details of contact interactions and endorsement changes while ensuring clarity and accuracy in communication and maintaining compliance with company protocols and regulatory requirements.
- Provided guidance and support to coworkers, offering assistance and expertise to ensure smooth operations. Additionally, served as a reliable backup in the absence of teammates, ensuring continuity and efficiency within the team.
Education
Business Administration
Wayne County Community College
Detroit, MIMarketing
Eastern Michigan University
Ypsilanti, MIHigh School Diploma -
High School of Commerce And Business Administratio
Detroit, MISkills
- Customer Support
- Staff Training
- Call Center
- Credit Card Processing
- CRM Software
- Compliant Resolution
Certification
- HIPAA
- Bloodborne Pathogen (BBP)
Timeline
Customer Service Advocate II
Centene, Meridian Health Plan of MI
03.2021 - Current
Customer Service Representative
R1 Rcm
10.2018 - 11.2020
Production Operator
FCA Trenton Engine
04.2018 - 09.2018
Customer Support Representative/Senior Data Entry Specialist
Auto Club Group AAA
10.2012 - 04.2018
- HIPAA
- Bloodborne Pathogen (BBP)
Business Administration
Wayne County Community College
Marketing
Eastern Michigan University
High School Diploma -
High School of Commerce And Business Administratio
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