- Participating in fundraising events to support local charities, schools, or community projects
- Getting involved in local advocacy groups to promote positive change in the community
- Developing software, websites, and apps in various programming languages
- Artificial Intelligence (AI) and Machine Learning
- Personal Development and Self-Improvement
Rhonda Hayes
Inverness,FL
Summary
Dynamic customer service professional with over 30 years of experience in call center operations and office environments, particularly in the insurance and risk management sectors. Expertise in thriving in high-volume, high-stress settings while demonstrating exceptional communication skills, meticulous attention to detail, and a steadfast commitment to customer service excellence. Proactive problem-solver dedicated to delivering superior support and fostering positive outcomes for clients and the organization. Known for maintaining an optimistic attitude, quickly adapting to new challenges, and advocating for the development of strong client relationships.
Overview
33
33
years of professional experience
1
1
Certification
Work History
Insurance Agent Support Specialist II
Humana
05.2024 - Current
- Provide prompt and effective sales support to Humana's agents, ensuring compliance and accurate member enrollment.
- Manage high volume of inbound calls, assisting insurance agents with pre-enrollment inquiries and commission issues.
- Streamlined agent compliance processes, improving efficiency and accuracy in contracting, licensing, and certification.
- Utilize strong critical thinking skills to resolve agent issues, enhancing overall agent satisfaction and performance.
- They have contributed to measurable improvements in agent support metrics, positively impacting sales and customer service.
- Facilitates agent compliance and enrollment, ensuring smooth processes and high satisfaction in a high-volume call environment.
- Analyzes inbound queries to streamline agent support, improving response times and overall service quality.
- Achieves measurable improvements in agent satisfaction by efficiently managing pre-enrollment and compliance inquiries.
- Analyzes agent inquiries to streamline support processes, achieving measurable response times and service quality improvements.
- Develops and implements compliance processes, significantly improving efficiency and accuracy in agent contracting and certification.
- Develop and implement compliance processes, enhancing agent contracting accuracy and efficiency.
- Facilitates agent compliance and enrollment, ensuring smooth processes and high satisfaction in a high-volume call environment.
- Achieves measurable improvements in agent satisfaction by efficiently managing pre-enrollment and compliance inquiries.
- Streamlined agent compliance processes, improving efficiency and accuracy in contracting, licensing, and certification.
- Implement new compliance procedures, drastically improving agent licensing accuracy and operational efficiency.
- Conducted detailed analysis of agent inquiries, optimizing support processes and reducing response times significantly.
- Seamless agent enrollment and compliance, ensuring high satisfaction and smooth operations in a high-volume environment.
Claims Research /Resolution Specialist
Evi core/Cigna Healthcare
09.2022 - 05.2024
- Conducted comprehensive research and resolved complex claims, ensuring compliance and accuracy.
- Review appeals meticulously, improving approval rates and reducing processing errors.
- Collaborate with insurance payors for timely payments, enhancing cash flow and inter-departmental coordination.
- Address inquiries and resolve complaints, significantly boosting customer satisfaction.
- Identify and rectify claims errors, contribute to improved operational efficiency, and reduce rework.
- Coordinate with cross-functional teams to streamline claims research, fostering a collaborative environment that enhances overall workflow.
- Identify and correct claim errors to boost efficiency and lower error rates.
- Provide exceptional support to clients and colleagues, demonstrating effective communication skills and a commitment to excellent service delivery.
- Streamline claims resolution to reduce processing time and improve accuracy with careful mindfulness.
- Partners with cross-functional teams streamline claims processes, enhance workflow and operational efficiency.
- Conduct detailed data analysis to identify trends and root causes of claim issues, driving process improvements and accuracy.
- Implement process enhancements that reduce claim processing time and improve accuracy, contributing to overall operational success.
- Develop and execute strategies to optimize claims handling, resulting in measurable improvements in efficiency and error reduction.
- Conducted thorough data analysis to uncover trends and root causes of claim issues, driving strategic process improvements.
- Worked closely with cross-functional teams to enhance claims research, fostering a more efficient and cooperative workflow.
- Implement strategies that optimize claims handling, resulting in significant efficiency gains and error reductions.
Property and Cat Claims Adjuster
Eberl Claims Service / State Farm Contract
09.2020 - 09.2023
- Eberl Claims service / Contracted with State Farm at Remote
- Manage special lines auto claims, evaluate damages, prepare estimates, and process payments.
- Review policies, investigate claims, and ensure fair settlements to reduce loss ratio.
- Transmit claims for further investigation or payment processing.
- Organize and retrieve data using specialized software for detailed office records.
- Contribute to reduced loss ratios through efficient claims management and settlement.
- Assessment and settlement of diverse special line claims, ensuring accurate damage evaluation and reducing overall loss ratios.
- Conduct thorough investigations and policy reviews to determine coverage, facilitate fair claim settlements, and improve customer satisfaction.
- Coordinate with team members to manage detailed records using specialized software, enhancing data retrieval and workflow efficiency.
- Streamlined claim transmission processes, accelerating payments and investigations, and contributing to operational improvements.
- Implement new methods for evaluating repair versus replacement options, optimizing claim resolutions, and cost management.
- Analyze complex auto claims, enhancing damage assessment accuracy and improving settlement efficiency.
- Conducted meticulous policy reviews, ensuring comprehensive claim investigations and facilitating fair settlements.
- Support team initiatives by enhancing record-keeping processes, contributing to improved workflow, and reducing loss ratios.
- Complex auto claim assessments, delivering precise damage evaluations, and expediting fair settlements, enhancing customer trust.
Remote Healthcare Customer Service Representative
TeleTech Inc
09.2019 - 03.2020
- Collaborated with healthcare providers to coordinate appointments, referrals, and authorizations for medical procedures.
- Assisted in the resolution of billing discrepancies by working closely with insurance companies and patients to ensure accurate payment processing.
- Maintained detailed records of customer interactions using CRM software, to document reference Demonstrated strong knowledge of healthcare products and services, effectively explaining coverage options and benefits to customers Managed a high volume of incoming calls in a fast-paced environment, consistently meeting or exceeding call-handling metrics Provided exceptional customer service to patients and their families, addressing inquiries, resolving issues, and ensuring a positive experience
- Resolve client insurance claims and inquiries, ensuring accurate information and guidance.
- Directed clients to appropriate resources, enhancing issue resolution efficiency.
- Provide policy support for a leading health insurance organization, improving client satisfaction.
- Addressed medical benefits questions, facilitated clear communication.
Virtual Customer Service Representative
Summit client services
12.2018 - 08.2019
- Managed high-volume inquiries, enhancing customer experience. Provided exceptional customer service and support to virtual customers via phone, email, and chat.
- Resolved customer inquiries and issues promptly and effectively, maintaining an elevated level of customer satisfaction.
- Developed rapport with virtual customers by actively listening to their concerns and providing empathetic support.
- Achieved high customer satisfaction scores by promptly resolving complex technical issues, leading to positive client feedback.
Security Site Supervisor
Securitas Security Services
08.2017 - 12.2018
- Supervised security team at a corporate site with 80+ companies, ensuring high service quality.
- Manage operations efficiently, achieving service and profitability goals.
- Coordinate new client transitions, enhancing client satisfaction and retention.
- Implement strict security procedures, preventing financial losses and unauthorized access.
- Conducted safety inspections, identified hazards, and ensured a safe work environment.
- Supervised and managed a team of security officers, ensuring efficient operations and client satisfaction through effective supervision and training.
- Implemented strict security protocols, reducing unauthorized access and enhancing overall site safety.
- Conducted periodic safety inspections, identifying potential hazards and overseeing corrective actions to prevent incidents.
- Enforced security policies, removed violators, and maintained a secure environment, collaborating with law enforcement as needed.
- Compiled and submitted detailed daily reports, documenting security operations and incident resolutions for record-keeping and analysis.
- Directed security operations for a corporate site with 80+ companies, ensuring compliance with stringent security standards.
Security Officer II
U. S. Security Associates
02.2017 - 08.2017
- Secure the premises and personnel by patrolling and monitoring with surveillance equipment.
- Reporting all irregularities and informing violators of policies, ensuring safety and compliance.
- Monitored and inspected buildings, equipment, and access points, maintaining detailed logs.
- Protecting the property and guests by regularly circulating premises and monitoring surveillance.
- Regulated vehicle and pedestrian traffic, ensuring authorized access and security.
- Led a team of officers in securing premises, ensuring safety protocols were followed, and addressing security breaches promptly.
- Conducted thorough inspections of buildings and equipment, identifying and addressing security vulnerabilities to prevent unauthorized access.
- Reviewed surveillance footage to detect and report irregularities, contributing to a significant reduction in security incidents.
- Attended all staff meetings and professional development activities to enhance team performance and security measures.
- Regulated vehicle and pedestrian traffic, ensuring smooth and secure access to facilities, and enhancing overall security.
- Enhanced security protocols and reduced incidents by conducting thorough inspections and addressing vulnerabilities promptly.
Customer Service Representative
Asurion LLC
08.2014 - 06.2015
- Managed inbound technical support calls for Direct TV commercial clients, resolving issues efficiently.
- Achieved high customer satisfaction with one-call resolutions, enhancing client retention.
- Utilized effective communication skills to understand and address customer needs effectively.
- Collaborated with team members to improve service processes and reduce call times.
- Demonstrated patience and problem-solving abilities in high-pressure situations.
- Assisted Direct TV commercial clients with technical issues, enhancing customer satisfaction and achieving one-call resolution.
- Resolved technical inquiries for Direct TV clients, driving high customer satisfaction and efficiency in remote troubleshooting.
- Analyzed and resolved technical problems for Direct TV customers, ensuring thorough understanding and effective solutions.
- Provided remote technical support to Direct TV clients, fostering positive customer experiences through patience and understanding.
- Diagnosed and resolved technical issues for Direct TV clients, improving service reliability and customer satisfaction.
- I managed inbound technical support calls for Direct TV commercial clients, consistently achieving one call resolutions and high customer satisfaction. I used effective communication skills to understand and address customer needs effectively and collaborated with team members to improve service processes. Additionally, I provided remote technical support, diagnosed and resolved technical issues, and offered detailed technical guidance to enhance customer satisfaction and experience. Detailed technical guidance to Direct TV commercial clients, enhancing overall customer experience and satisfaction.
Customer Service Representative
APAC Customer Service Inc
02.2014 - 07.2014
- Managed 70+ customer calls per hour, resolving package delays and providing tracking updates.
- Collaborated with UPS logistics team to streamline package tracking and improve communication.
- Addressed diverse package issues, offering tailored solutions to maintain high service standards.
- Enhanced customer experience by offering multiple delivery options and timely updates.
- Reduced average call response time, significantly improving customer satisfaction and efficiency.
- Analyzed customer feedback to identify common issues, contributing to process improvements.
- Provided empathetic customer support, addressing diverse concerns and ensuring high satisfaction.
- Implemented multiple delivery options, enhancing customer experience and reducing package delays.
- Leveraged customer feedback to refine processes, enhance service quality and operational efficiency.
- Worked closely with cross-functional teams to resolve logistics issues, ensuring timely and accurate package deliveries.
- Utilized data analysis to identify trends in customer inquiries, driving continuous improvement initiatives.
Director of Client Relations
National Marketing Services
11.2011 - 10.2013
- Cultivated and maintained client relationships to ensure elevated levels of satisfaction and loyalty.
- Resolved client issues and improved operational efficiency by implementing new filing systems.
- Conducted business reviews and satisfaction surveys to identify opportunities for sales growth.
- Collaborated with the sales team to achieve client relationship targets and key performance indicators (KPIs).
- Monitored company performance against service level agreements (SLAs), addressing potential issues promptly.
- Facilitated cross-departmental coordination to resolve client issues, thereby enhancing client satisfaction and loyalty.
- Implemented new filing systems, which increased operational efficiency and safeguarded confidential client records.
- Conducted business reviews and client satisfaction surveys to identify areas for improvement in meeting service-level agreements.
- Developed training programs for sales representatives to improve their closing schedules and overall sales performance.
- Advised clients on additional products, generating recent sales opportunities and boosting company revenue.
- Led cross-functional teams to enhance client satisfaction, achieving seamless resolutions for complex issues.
- Nurtured long-term client relationships through regular communication channels, including phone calls and emails.
- Mentored junior members of the sales team through regular coaching sessions and skill development workshops.
- Analyzed sales data to identify trends, patterns, and areas for improvement, leading to targeted sales strategies.
- Managed key accounts to ensure elevated levels of customer satisfaction and repeat business.
- Conducted regular training sessions for the sales team on product knowledge, objection-handling techniques, and effective closing strategies.
- Created compelling sales presentations tailored to specific client needs, effectively communicating the value propositions of products or services offered.
- Developed pricing strategies based on market analysis and competitive positioning to maximize profitability while maintaining customer satisfaction levels.
- Collaborated with cross-functional teams, including marketing, product development, and operations, to ensure alignment of business objectives. teams, including marketing, product development, and operations, to align key business objectives.
Supervisor of Operations
Summit Adult Care
04.2009 - 10.2011
- Supervised staff and managed personnel files and schedules, ensuring operational efficiency.
- Coordinated patient appointments and insurance, maintaining state licensing compliance.
- Conducted safety audits, enforcing regulatory policies to improve workplace safety.
- Implemented strategies to enhance operational accuracy, achieving measurable improvements.
- Streamlined staff scheduling and personnel management, enhancing operational efficiency and reducing administrative errors.
- Led compliance efforts, ensuring adherence to state licensing and regulations, resulting in improved facility safety and readiness.
- Developed and implemented new strategies to improve operational accuracy, leading to measurable improvements in workflow.
- Coordinated patient appointments and insurance with precision, directly contributing to seamless healthcare delivery.
- Conducted regular safety audits to ensure compliance with administrative policies, maintaining lofty standards of operational safety.
- Designed and implemented a new patient scheduling system, significantly reducing appointment overlaps and enhancing patient satisfaction.
- Utilized data-driven approach to refine insurance coordination processes, ensuring compliance and minimizing claim rejections.
- Mentored and trained inexperienced staff, fostering a collaborative work environment and enhancing team productivity.
- Conducted meticulous reviews of personnel files, ensuring accuracy and compliance with state regulations. Supervised staff and managed personnel files and schedules to ensure operational efficiency.
Personal Lines Insurance Agent Licensed
Progressive Auto Insurance
02.2001 - 08.2006
- Advised policyholders on claim filing steps and required information, ensuring smooth processes.
- Sold personal lines policies, tailoring custom insurance programs for unique client needs.
- Addressed customer inquiries regarding policies, billing, and coverage changes.
- Maintained and updated customer records, assisting with policy renewals and claims resolution.
- Provided policy services and underwriting, ensuring comprehensive coverage for clients.
- Expertly guided policyholders through claim processes, ensuring compliance and timely resolutions, boosting client trust.
- Collaborated closely with underwriting team to assess risk and develop comprehensive coverage plans, ensuring optimal client protection.
- Analyzed client policies to identify gaps, recommending necessary changes to enhance coverage and mitigate potential risks.
- Drove sales of personal lines policies, consistently meeting and exceeding sales targets, contributing to overall company growth.
- Cultivated strong client relationships by proactively addressing policyholder concerns, enhancing retention rates and customer satisfaction.
- Collaborated with cross-functional teams to streamline policy issuance processes, improving efficiency and reducing turnaround times.
Workers' Compensation Claim Representative
Wausau Nationwide Insurance Company
11.1999 - 01.2001
- Managed intake of workers' compensation claims, communicating with all relevant parties.
- Reviewed and prompted action on established claims, ensuring timely closure or settlement.
- Conducted thorough investigations to determine coverage, liability, and damages.
- Took recorded statements and assigned resources, including vendor partners and Defense Counsel.
- Identified questionable claims, consulting with SIU for further direction as needed.
- Reviewed and analyzed workers' comp claims, ensuring timely settlements and accurate liability assessments.
- Communicated with injured employees, physicians, and attorneys to facilitate smooth claim processes and settlements.
- Conducted thorough investigations, including accident reports and witness statements, to determine claim validity and liability.
- Managed and resolved claims efficiently, reducing processing time and improving overall claim resolution rates.
- Provided clear documentation and recommendations for claim settlements, aiding in informed decision-making for higher authority levels.
- Analyzed and managed claims data, identifying trends to improve operational efficiency and reduce claim processing times.
Medicare and More Policy Services Agent
Blue Cross Blue Shield
04.1996 - 03.1999
- Addressed customer inquiries on insurance policies and programs, ensuring accurate information delivery.
- Processed PCP, billing, and address changes, maintaining up-to-date customer records.
- Collaborated with team to manage Blue Cross and Blue Shield Medicare accounts for Florida state employees.
- Resolved issues efficiently, leading to improved customer satisfaction and retention.
- Utilized analytical skills to identify and address policy discrepancies, enhancing service quality.
- Led resolution of customer inquiries on insurance policies, driving improved satisfaction for Florida's retired employees under Medicare and More.
- Managed policy and billing updates, ensuring accuracy and compliance for Blue Cross Blue Shield's Medicare and More accounts.
- Collaborated closely with a resolute team to address customer concerns, enhancing service quality for the
- Executed precise PCP and address changes, contributing to streamlined operations for Blue Cross Blue Shield
Auto Claims Intake Supervisor
Armor Auto Insurance
05.1993 - 03.1996
- Managed and trained a team of 12-15 auto claims intake representatives, ensuring accurate reporting.
- Oversaw the review of records and documentation to confirm insurance coverage and compliance.
- Guided claims management staff, providing support and managing special claims cases.
- I interacted with claimants to facilitate smooth claims progression and resolution.
- Supervised the claims adjudication process, ensuring adherence to CMS rules and regulations.
- Led and trained a team of 12-15 representatives, ensuring accurate claim intake and adherence to CMS rules, enhancing overall process efficiency.
- Facilitated seamless interaction with claimants and guided management staff, fostering a supportive and effective claims environment.
- Oversaw review of records to determine insurance coverage, ensuring compliance and accuracy in documentation, and mitigating potential errors.
- Managed special claims, including workers' compensation and Medicare, delivering timely and precise resolutions, driving company success.
- Monitored claims adjudication processes, ensuring examiners followed CMS regulations and maintained lofty standards of claim processing integrity.
- Coordinated cross-functional teams streamline claims processes, enhancing efficiency and reducing resolution time.
Education
Diploma - Certified Information Systems Security Professional (CISSP 2019)
Alison. com
04-2026
Diploma - Modern Human Resource Management
Alison. com
04-2026
Diploma - Computer Networking
Alison. com
04-2026
Diploma - Risk Management in Insurance
Alison. com
04-2026
Associate's degree - Computer Networking and Telecommunication
University of Phoenix
Tampa, FL06-2010
High school diploma - undefined
Chamberlain High School
Tampa, FL06-1993
Skills
- Insurance sales HIPAA
- Microsoft Office PowerPoint
- Customer Service Auto estimating
- Additional information
- Negotiation Background investigations
- Medicare Sales
- Billing Client Relations
- Microsoft Word Management
- Microsoft Access Conflict management
- Conflict resolution Analysis
- ICD coding Call center
- Theft prevention technical support
- Content management ClaimXperience
- Supervising Leadership
- Workers' Compensation Team Management
- CRM software Underwriting
- Surveillance Xactimate
- Safety Telecommunication
- Microsoft Excel E-commerce
Accomplishments
2012 become a registered forster parent, and Home school parent to my high autistic son become certified in IEP for special needs
Affiliations
- Toastmasters
- Society of Human Resource Management
- Association of Information Technology Professionals
- National Notary Association
Certification
- Claims adjuster's license
- Personal Lines License
- Property & Casualty License
- BLS Certification
- Certified Notary Public
Interests
Quote
There is a powerful driving force inside every human being that, once unleashed, can make any vision, dream, or desire a reality.
Tony Robbins
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Timeline
Insurance Agent Support Specialist II
Humana
05.2024 - Current
Claims Research /Resolution Specialist
Evi core/Cigna Healthcare
09.2022 - 05.2024
Property and Cat Claims Adjuster
Eberl Claims Service / State Farm Contract
09.2020 - 09.2023
Remote Healthcare Customer Service Representative
TeleTech Inc
09.2019 - 03.2020
Virtual Customer Service Representative
Summit client services
12.2018 - 08.2019
Security Site Supervisor
Securitas Security Services
08.2017 - 12.2018
Security Officer II
U. S. Security Associates
02.2017 - 08.2017
Customer Service Representative
Asurion LLC
08.2014 - 06.2015
Customer Service Representative
APAC Customer Service Inc
02.2014 - 07.2014
Director of Client Relations
National Marketing Services
11.2011 - 10.2013
Supervisor of Operations
Summit Adult Care
04.2009 - 10.2011
Personal Lines Insurance Agent Licensed
Progressive Auto Insurance
02.2001 - 08.2006
Workers' Compensation Claim Representative
Wausau Nationwide Insurance Company
11.1999 - 01.2001
Medicare and More Policy Services Agent
Blue Cross Blue Shield
04.1996 - 03.1999
Auto Claims Intake Supervisor
Armor Auto Insurance
05.1993 - 03.1996
Diploma - Modern Human Resource Management
Alison. com
Diploma - Computer Networking
Alison. com
Diploma - Risk Management in Insurance
Alison. com
Associate's degree - Computer Networking and Telecommunication
University of Phoenix
High school diploma - undefined
Chamberlain High School
Diploma - Certified Information Systems Security Professional (CISSP 2019)
Alison. com