Renee J. Stewart
Jacksonville,Florida
Summary
Dedicated healthcare service professional with a proven track record of enhancing patient communication and resolving complex issues. Expertise in managing patient inquiries, collaborating with medical teams, and ensuring seamless service delivery. Recognized for a strong commitment to teamwork and adaptability, consistently achieving exceptional results in high-pressure environments. Renowned for empathy, active listening, and effective conflict resolution skills that foster positive patient experiences.
Overview
29
29
years of professional experience
1
1
Certification
Work History
Quality Auditor - Operational Performance & Regulatory Services
Florida Blue
10.2016 - 06.2025
- Monitors and evaluates the quality of inbound and/or outbound telephone calls.
- Interpretation and compliance with policies and procedures.
- Audit all aspects of enrollment, billing and benefit processes including financials, enrollments, changes, new groups, and renewals.
- Documents quality issues and performance measures for management review.
- Performs research to respond to inquiries and interpret policy provisions to determine most effective response.
- Conducts detailed analyses to determine root causes and identifies improvement opportunities.
- Develops, distributes and presents reports to management regarding defects and trends identified through audits; recommends improvements, training opportunities, etc.
- Research guidelines to determine if an action is complying.
- Maintained a strong understanding of industry regulations and ensured company compliance through regular audits.
- Ensured timely completion of all assigned audits while maintaining a high level of detail and accuracy.
- Identified issues of non-compliance and elevated reports to senior personnel.
- Educated and oriented employees to improve compliance with quality control protocols.
- Trained new Quality Auditors on best practices, increasing their proficiency in performing audits effectively.
- Participated in cross-functional team meetings, contributing valuable insights from an auditor''s perspective to facilitate process improvements.
- Conducted root cause analysis of non-conformities, implementing appropriate corrective actions to prevent recurrence.
- Supported continuous improvement initiatives by identifying opportunities for enhancing product quality during audits.
- Scheduled and executed 1,728 yearly audits.
Service Advocate IV-Group Enrollment Membership and Billing
Florida Blue
04.2013 - 10.2016
- Establishing and maintaining group and/or member enrollment and billing in a timely manner to minimize financial risk and to ensure department and corporate goals are met.
- Serves as a contact for internal and external customers to resolve enrollment, membership, and billing issues.
- Supported team members, fostering a collaborative and productive work environment.
- Improved customer satisfaction by promptly addressing inquiries and resolving issues.
- Demonstrated empathy and active listening skills when dealing with frustrated customers, diffusing tense situations effectively.
- Handled escalations professionally, demonstrating composure under pressure while finding satisfactory solutions for both parties involved.
- Exceeded performance metrics consistently by prioritizing tasks effectively and efficiently.
- Managed approximately 70 incoming calls per day with an AHT under 5:00 minutes.
- Enhanced client retention through exceptional service delivery and proactive communication.
- Analyzed customers' issues and complaints and initiated corrective actions.
Service Advocate/Training Assistant
Florida Blue - Blue Cross Blue Shield Of Florida
04.2015 - 10.2016
- Resolve customer escalations received through multiple channels of inbound & outbound phone calls, written, faxes, etc.
- Ability to build strong working relationships with internal business partners.
- Assisted in training new employees, sharing best practices for achieving success as a Service Advocate.
- Reduced average call duration by implementing time-saving techniques without compromising on service quality.
- Trained and mentored 35 new personnel hired to fulfill various roles.
Assistant Individual Medical Underwriter
Florida Blue/Incepture
01.2011 - 04.2013
- Responsible for underwriting all new business individual applications for all traditionally medically underwritten products.
- Determine the insurability of each proposed insured through the evaluation of medical, non-medical, demographic and psychographic factors and contract elements.
- Support a retail storefront, being accessible during business and extended hours.
- Implemented a comprehensive monitoring system to track policyholder health status, resulting in more informed underwriting decisions.
- Streamlined underwriting processes for faster decision-making through the implementation of automated tools.
Specialized Case Management
PRUDENTIAL FINANCIAL
05.1996 - 12.2009
- Customer Service Specialist-Life Insurance Call center 1996-1998
- Specialized Case Management Unit-Mutual Funds Division1998-2003
- Wealth Management Advisor- Annuity Service Center-2003-2006
- Relationship Management Team-New Business/Underwriting 2006-2009
- Customer Service Call Center- Anticipate and understand client needs and concerns by assisting with Billing inquiries, explained policy benefits and contract values. Processed loans, premium discrepancies, misapplied payments, fund withdrawals and first stage death claims.
- Annuities/Mutual Funds- assisted customers with making fund changes and navigating various online tools to retrieve values and request forms for changes. Explained tax consequences on premature distribution, fostered collaborative relationships within and across business units and sectors, educated customers on the financial vehicles available based on their financial goals. Served as New Hire coach and mentor.
- New business underwriting- Assisted proficient agents with underwriting requirements: responsibilities includes ordering medical records, background checks, drug screen and establishing financial suitability via an outbound call back interview with the perspective customer. Assisted agent with all necessary forms needed to comply with HIPPA regulations. Ability to multi-task, and work in a fast-paced environment.
- Received 98% call and documents quality for 3 consecutive years.
Education
B.S Degree - Management
University of Phoenix
Orlando, FL05.2010
Skills
- Complaint handling
- Data entry
- Excellent analytical and problem-solving skills
- HIPAA compliance
- Call center experience
- Customer focus
- Active listening
- Critical thinking
- Data collection
- Microsoft Office Suite
- Customer education
- Research
Certification
- LEAN Six Sigma Green Belt Certification
- Dale Carnegie Sales and Public Speaking
- Gap consulting firm –Training in team building and Self- self-directed workgroups
Timeline
Quality Auditor - Operational Performance & Regulatory Services
Florida Blue
10.2016 - 06.2025
Service Advocate/Training Assistant
Florida Blue - Blue Cross Blue Shield Of Florida
04.2015 - 10.2016
Service Advocate IV-Group Enrollment Membership and Billing
Florida Blue
04.2013 - 10.2016
Assistant Individual Medical Underwriter
Florida Blue/Incepture
01.2011 - 04.2013
Specialized Case Management
PRUDENTIAL FINANCIAL
05.1996 - 12.2009
B.S Degree - Management
University of Phoenix
System Knowledge
RBMS, Siebel, Nice, HPS, Oracle, Prime, EIP, Microsoft Office Suite, Client Letter, VPI, Enroll Point, Blues Enroll, Help File, Share Point, K360, Customer Connect
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