Sachelle Moses
Brandon,FL
Summary
Experienced Customer Care Representative with 12+ years in providing telephonic support to patients, customers, and providers, managed care and utilization review, delivering accurate, timely medical necessity determinations and strong provider relations. Skilled in analyzing clinical documentation, interpreting guidelines, resolving complex cases and billing discrepancies, and coordinating cross-functional decisions. Recognized for clear communication, critical thinking, and data accuracy with a member-first approach and solid Microsoft proficiency.
Overview
17
17
years of professional experience
Work History
Customer Care Representative
Centene Health Plans
Tampa, FL
02.2013 - 09.2025
- Verified insurance and updated patient records when necessary.
- Communicate effectively with providers to obtain/clarify clinical information and support timely decisions
- Demonstrate strong provider relations skills
- Collaborate with cross-functional partners to resolve cases and support member/provider needs
- Performed medical necessity and clinical reviews of authorization request to determine medical appropriateness of care in accordance with regulatory guidelines and criteria
- Handled billing issues and account discrepancies with accuracy and professionalism
- Handled all other assigned duty tasks
- Handled inbound and outbound calls to identify patient needs and provide appropriate support.
- Resolved caller inquiries using internal resources and escalate when needed.
- Maintain patient confidentiality in accordance with company policies and HIPAA regulations.
Pharmacy Assistant
Summerfield Pharmacy
Riverview, FL
01.2009 - 12.2010
- Delivered exceptional customer service by effectively addressing patient inquires and concerns, fostering a positive experience
- Answering inbound calls from providers and customers
- Managed patient records
- Maintained a clean, organized workplace for meeting and consultations
Education
High School Diploma - undefined
Tampa Bay Technical High School
Tampa, FL05.2003
Skills
- Adaptability/Flexibility Expert
- Critical Thinking Expert
- Understanding of Medical Terminology Expert
- Data Entry Expert
- Computer Skills (Microsoft) Expert
- Strong interpersonal and active listening skills
- Ability to troubleshoot and follow up on customer issues
Timeline
Customer Care Representative
Centene Health Plans
02.2013 - 09.2025
Pharmacy Assistant
Summerfield Pharmacy
01.2009 - 12.2010
High School Diploma - undefined
Tampa Bay Technical High School