Riccia Thomas
Tacoma,WA
Summary
Well-trained service advocate with several years of experience helping others. Excellent decision-making and time management skills. Sound knowledge of handling escalated issues quickly. Adapts quickly and remains calm under pressure in stressful circumstances. I am excited to bring my proven skills and customer enthusiasm to a company that encourages career growth and opportunity.
Well-trained service advocate with several years of experience helping others. Excellent decision-making and time management skills. Sound knowledge of handling escalated issues quickly. Adapts quickly and remains calm under pressure in stressful circumstances.
Overview
8
8
years of professional experience
1
1
Certification
Work History
Remote Service Advocate
Optum Care Network
Tacoma, WA
02.2020 - 04.2024
- In my role of the Remote Services Advocate my job was to build trusted relationships with members across their health care lifecycle
- This is done by assisting members with their customer service needs, educating members about management of their health and well being, helping members to maximize health plan benefits and personal health care dollars and owning customer service inquiries through to resolution
- Another purpose of this position is to support the mission, vision and values of the organization and department through quality, service, innovation, integrity, teamwork and dignity respect
- Accountable for problem resolution of customer issues and to communicate resolution to appropriate parties
- Available, as scheduled, to respond to calls from customers regarding claims payments, benefits, eligibility, and certification issues
- Investigate issues and document steps taken to achieve resolution
- Manage resolution of issues through contact with the claims department, case management, and external payers ultimately achieving a positive outcome
- Investigate and handle retro certification activities, as required for resolution of customer issues
- Respond to customers regarding status of formal complaints or appeals
- Escalate issues to Senior Customer Service Reps when appropriate
- Meet departmental standards for schedule adherence
- Demonstrate a basic knowledge of managed healthcare and claims
- Perform all other duties as deemed appropriate to provide remote customer service
- Answer and respond to member inquiries regarding effective and efficient handling of incoming call claim issues
- Adhere to quality improvement initiatives
- Special projects as required
- Educate members about the fundamentals of consumer driven health care
- Own problem through to resolution on behalf of the member in real time or through comprehensive and timely follow up with the member
- Help members navigate myuhc.com, lifeprinthealth.com, and other UnitedHealth Group websites
- Research complex issues across multiple databases and work with support resources to resolve member issues
- Connect members with internal specialists for assistance when needed
- Partner with others to resolve escalated issues
- Mentor new hires and existing staff in the efficient use of call handling best practices designed to ensure accurate and consistent call responses
- Launch outbound calls as appropriate
Intake Coordinator/Care Navigator
Northwest Integrated Health
07.2019 - 01.2020
- As Intake Coordinator I received incoming calls for all new patients, recorded all patient demographics, screened patients to determine the type of appointment to be scheduled
- Verifies eligibility of insurance and all benefits using internet-based eligibility systems and/or insurance websites available communicates insurance eligibility and financial responsibility with patients
- Schedules appointments and distributes appropriate paperwork and information to the location of the patient appointments
- Assist with transportation to and from facility
- I worked in conjunction with other intake coordinator and office staff to ensure a smooth transition of clinical schedules and that all referrals and authorizations have been completed
- Schedule intake assessment
- Request and secure medical records before intake assessment, ensuring adequate releases of information are in place
- Intake Assessment
- Scheduling
- Processing and managing of referral paperwork
- Assess patient needs to match patient to an appropriate provider
- Assist with Community resources
- Provide outreach, engagement and supportive services
Provider/Customer Service Specialist
Coordinated Care
11.2015 - 01.2019
- Resolve customer inquiries via telephone and written correspondence in a timely and appropriate manner
- Reference current materials to answer escalated and complex inquiries from members and providers regarding claims, eligibility, covered benefits and authorization status matters
- Provide assistance to members and/or providers regarding website registration and navigation
- Educate members and/or providers on health plan initiatives
- Provide first call resolution working with appropriate internal/external resources, and ensure closure of all inquiries
- Document all activities for quality and metrics reporting through the Customer Relationship Management (CRM) application
- Address written customer correspondence and provide the appropriate level of follow-up in a timely manner
- Research and identify processing inaccuracies in claim payments and route to the appropriate team for claim adjustment
- Identify trends related to member and/or provider inquiries that may lead to policy or process improvements that support excellent customer service and impact quality and performance standards
- Work with other departments on cross-functional tasks and projects
- Maintain performance and quality standards based on established call center metrics including turn-around times
Education
Certificate in Peer Counseling - mental health recovery course, state training, state certification test, online peer counselor class
12.2020
Certificate -
Bates Technical College
01.2007
High School -
Stadium High School
01.2005
Skills
- Sabre/Apollo/Galileo
- Knowledge Base
- Quality Assurance
- Remote troubleshooting
- Compliance and Policy
- Chat Support
- KPIs
- Decision-making skills
- Complex Problem-Solving
- Benefits Administration
- Document Review
- Complaint Handling
- Call handling
- Customer service background
- Research proficiency
- Technical Support
- Attention to Detail
- Data Entry and 10-Key
Certification
Certificate in Peer Counseling, 07/01/19, 12/31/20, Mental health recovery course completed, State training completed, State certification test completed, Online peer counselor class completed
Knowledgeandskills
- Sabre/Apollo/Galileo
- Knowledge Base
- Quality Assurance
- Technical/Remote troubleshooting
- Compliance and Policy
- Chat Support
- KPIs
Timeline
Remote Service Advocate
Optum Care Network
02.2020 - 04.2024
Intake Coordinator/Care Navigator
Northwest Integrated Health
07.2019 - 01.2020
Provider/Customer Service Specialist
Coordinated Care
11.2015 - 01.2019
Certificate in Peer Counseling - mental health recovery course, state training, state certification test, online peer counselor class
Certificate -
Bates Technical College
High School -
Stadium High School