Roxane Reyes
Houston
Summary
Accomplished Team Lead with extensive experience in training development and quality assurance within the insurance sector. Developed innovative training programs that improved team efficiency, reduced error rates, and enhanced customer satisfaction metrics, including NPS and CSAT scores.
Overview
20
20
years of professional experience
Work History
Customer Service Representative III
Apex Health Solutions
Houston
07.2024 - Current
- Collaborated with customer service team lead to ensure timely support for inquiries and transitions.
- Identified call trends, reported negative patterns, and facilitated discussions for service improvement.
- Assisted customer service representatives with escalated calls related to medical benefits referrals and pre-certifications.
- Developed comprehensive training materials for call center staff enhancement.
- Reviewed departmental policies and procedures to identify necessary updates.
Insurance Verification Specialist
Kelsey Seybold Clinic
07.2023 - Current
- Verified insurance policy benefits for new and returning patients, ensuring accurate coverage for various carriers.
- Coordinated benefits verification and organized filing order for clinic services, facilitating efficient patient processing.
- Prepared patient pre-treatment cost share based on contracted plan allowances and thresholds.
- Explained coverage details and financial liability to patients, providing clear pre-treatment cost estimates to support informed decision-making.
- Identified special policy clauses and pre-existing conditions affecting coverage.
- Processed over-the-phone payments and established payment plans according to department policies.
Team Lead- Application Fulfillment Team
Covr Financial Technologies
03.2022 - 02.2023
- Managed application fulfillment team responsible for processing life insurance applications across various carriers.
- Conducted weekly quality assurance audits to ensure accurate application completion by agents.
- Reduced departmental error rate, ensuring accurate applications prepared for underwriting.
- Established process improvement procedures, enhancing accuracy among lower-performing agents.
- Developed and implemented training programs, including monthly refreshers on carrier updates.
- Collaborated with department manager to deploy innovative interactive training platform.
- Created and assigned daily appointment schedules for agents, improving outbound call efficiency.
- Contributed to increased NPS and CSAT scores by improving service quality.
Team Lead- Quality Assurance, Customer Service
Memorial Hermann Health Plan
09.2020 - 03.2022
- Developed methods to enhance team phone performance, resulting in improved talk time, hold time, and quality assurance metrics.
- Managed call activities for commercial and Medicare Advantage lines, improving overall operational efficiency.
- Audited internal customer service representatives to maintain compliance with departmental metrics.
- Reviewed applications and conducted interviews for prospective customer service representatives, ensuring alignment with team standards and needs.
- Coordinated monthly calibration meetings with third-party vendors to align performance standards.
- Collaborated with compliance teams to assess corrective action plans for third-party vendor issues.
- Provided management with weekly quality assurance results to identify trends affecting department performance.
- Oversaw payroll processes and audited employee FMLA time within attendance department.
Sr. Customer Service Representative, Customer Service
Memorial Hermann Health Plan
08.2013 - 09.2020
- Enhanced member and provider retention by delivering premium concierge service.
- Facilitated escalated calls regarding medical benefits, ensuring thorough support for providers and members.
- Coached and developed call center staff, improving performance and compliance.
- Ensured all representatives met health plan regulatory requirements and performance metrics.
- Supported customer service team lead in overseeing floor coverage and staff assistance.
- Participated in annual enrollment plan meetings with members and employer groups.
- Participated in benefit fairs and retention events, facilitating employer group Q&A sessions.
- Reviewed policies to identify necessary updates, communicating trends to relevant departments.
Patient Access Scheduling Representative, Customer Service
Harris Health System
08.2009 - 04.2013
- Managed incoming calls for clinic and hospital appointments, facilitating timely access to care for patients and healthcare staff.
- Managed appointment scheduling, including updates and cancellations, to maintain efficiency.
- Conducted eligibility screenings, insurance verifications, and financial counseling, streamlining patient access to necessary services.
- Processed patient registrations during scheduling to ensure accuracy and completeness, enhancing patient experience.
- Gathered patient demographics and insurance information to facilitate accurate registration.
- Supported hospital standards for customer satisfaction consistently throughout operations.
- Coordinated referrals to specialty departments to enhance patient care.
Assistant Sales Coach, Sales Department
E-tech Incorporated
02.2009 - 08.2009
- Coached team members, enhancing skills and driving improved performance.
- Presented effective training techniques to enhance skill sets and improve team performance.
- Supervised sales team of 16 employees, ensuring achievement of performance metrics.
- Demonstrated effective call techniques, including record disposition and software application.
- Monitored and resolved client account issues based on assigned reports.
Bilingual Customer Service Supervisor, Customer Service
Affiliated Computer Services
04.2006 - 07.2008
- Coached and trained team of 15+ representatives to consistently surpass company goals.
- Managed call center operations by mentoring staff and resolving inquiries to support team efficiency.
- Oversaw quality performance and productivity of customer service representatives to maintain high service standards.
- Monitored inbound call abandonment rates and agent performance metrics to pinpoint areas for improvement.
Education
High School -
JOHN H. REAGAN HIGH SCHOOL
Houston, TX06-2001
Skills
- Customer relations and escalations
- Data Collection and Analysis
- Zoom Quality Management
- Five9
- Cisco Finesse
- Cisco Jabber
- Teleopti
- CUIC
- EPIC
- Facets
- NaviClaimRx
- DMS
- EAM
- EZCAP
- MARx
- Meditrac
- IBM
- MS Office Suite
- Knowledge of Texas Department of Insurance
- Knowledge of Centers for Medicare and Medicaid
- Knowledge of Department of Labor and ERISA
- Zoom recording
- HRP
Languages
Bilingual English/Spanish
Career Overview
Experienced Team Lead with strong leadership and coordination skills. I possess 12 years of experience in the insurance industry and 8 years of experience in a leadership role. I have effectively trained and fostered a positive work environment to ensure quality regulations have been met and the department is working as efficiently as possible. I am in search of a position where I can utilize my current expertise and apply my leadership skills to motivate team members and increase quality and productivity within your organization.
Timeline
Customer Service Representative III
Apex Health Solutions
07.2024 - Current
Insurance Verification Specialist
Kelsey Seybold Clinic
07.2023 - Current
Team Lead- Application Fulfillment Team
Covr Financial Technologies
03.2022 - 02.2023
Team Lead- Quality Assurance, Customer Service
Memorial Hermann Health Plan
09.2020 - 03.2022
Sr. Customer Service Representative, Customer Service
Memorial Hermann Health Plan
08.2013 - 09.2020
Patient Access Scheduling Representative, Customer Service
Harris Health System
08.2009 - 04.2013
Assistant Sales Coach, Sales Department
E-tech Incorporated
02.2009 - 08.2009
Bilingual Customer Service Supervisor, Customer Service
Affiliated Computer Services
04.2006 - 07.2008
High School -
JOHN H. REAGAN HIGH SCHOOL