Hiking
Sara Spires
Snr. Consumer Experience Professional
Lakeland,FL
Summary
Systematic and experienced consumer experience professional with a detail-oriented and thorough approach to defining requirements, outlining specifications and working with team members to bring to life high-quality products for end-users. Comfortable working in Agile and Scrum methodologies. Good planner and problem-solver with in-depth understanding of CRM Salesforce products. Confident in making key decisions for team to move products efficiently through pre and post production timelines.
- OBJECTIVE: Continue to advance within the company by contributing to the continued success of Humana through the application of technological and service related experiences.
Highlights:
- Over 10 years of experience working in customer service and office management
- Proficiency in all Microsoft Office Programs
- CRM, CAS & GCP Proficiency
- Capacity to maintain confidentiality
- Very knowledgeable UAT tester that has excellent communication abilities and strong analytical and writing skills.
- Processes in-depth understanding of business client needs
- Expertise in deployment tools such as Azure and qTest
Overview
10
10
years of professional experience
Work History
Snr. Consumer Experience Professional
Humana
Lakeland- WAH, FL
05.2018 - Current
- Collaborated in team environment to produce high-quality enhancements for several desktop applications, including CRM Service Salesforce and DIG Toolbar.
- Led the ELITE Fellowship program to assist with quality assurance testing of functionality and validation of data with a 4 person team. Coordinated software testing to uncover bugs and troubleshoot desktop issues prior to application launch.
- Discussed project progress with Call Center customers, collected feedback on different stages and directly addressed concerns.
- Coordinated with Scrum Masters and Project Managers to evaluate and improve software interfaces.
- Gathered and defined customer requirements to develop clear specifications for project plans.
- Reviewed and incorporated latest technology innovations and development strategies to improve build speed, quality and end-user experience.
- Contributed ideas and suggestions in team meetings and delivered updates on deadlines, designs and enhancements.
Claims Research & Resolution Representative 4
Humana
Tampa, FL
11.2015 - 05.2018
- Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.
- Reported policy changes and company conditions affecting customer satisfaction.
- Used administrative guidelines as resource or to answer questions when processing medical claims.
- Managed large volume of medical claims on daily basis.
- Paid or denied medical claims based upon established claims processing criteria.
- Tracked outstanding work, employee production and inventory movements.
- Developed monthly and daily data reports to understand pain points and identify conflicts to improve team productivity.
- Supervised new employees and drove implementation of the CRU Phone a Friend Project. Responded quickly to questions, which improved understanding of role responsibilities.
Production lead; Customer Service Representative
Humana
Tampa, FL
10.2013 - 10.2015
- Assisted representatives and members by explaining and updating benefits, researching claims, and resolving complex issues.
- Make independent determinations based on contract language, benefit interpretation, medical management activities, regulatory interpretation, claims processing accuracy and an understanding of all systems used to provide and authorize service and payment.
- Maintain functional expertise of claims processing requirements as mandated by legislation, regulatory agencies and company policies.
- Analyze and interpret information and identify trends in order to address and resolve business-related issues.
- Chosen for special projects such as CRM Service deployment.
- Conferred with senior management to handle and correct disciplinary or knowledge issues.
- Boosted team spirit and performance by communicating clear service expectations and quality goals to each team member.
Customer Service Representative
Randstad- AON Hewitt
Orlando, FL
09.2012 - 02.2013
- Assisted clients by explaining and updating their benefits, including annual enrollment.
- Identified, researched and resolved caller’s issues using Microsoft tools, Lotus Notes, and company software.
Provider Resolution Specialist; Business Analyst; Call Center Supervisor
Blue Cross Blue Shield of South Carolina
Columbia, SC
08.2010 - 09.2012
- Medicare Competitive Bidding Implementation Contract, Responsible for answering escalated bidding requests and resolving issues received through transferred provider phone calls.
- Was a subject matter expert and handled more complex provider issues.
- Thoroughly researched bidding escalations and took appropriate action to resolve them within the allotted turnaround time requirements and quality standards.
- Acted as a liaison between internal departments on data gathering and problem solving while investigated problems of extreme importance.
- Provided appropriate level of coaching, analysis and resolution to CSR.
- Often assisted team member by guiding them to the appropriate resolution of the more complex and difficult cases.
- Identified root causes of issues and communicated my findings as needed to ensure that the issue would not occur again.
- Assisted with special projects regularly.
- Data analysis and software testing.
Education
No Degree - Early Childhood Development
University Of South Carolina - Columbia
Columbia, SC 08.2006 - 05.2008
High School Diploma -
Ridge View High School
Columbia, SC 08.2002 - 05.2006
Skills
Problem identification
undefinedQuote
Every problem is a gift—without problems we would not grow.
Tony Robbins
Interests
Timeline
Snr. Consumer Experience Professional
Humana
05.2018 - Current
Claims Research & Resolution Representative 4
Humana
11.2015 - 05.2018
Production lead; Customer Service Representative
Humana
10.2013 - 10.2015
Customer Service Representative
Randstad- AON Hewitt
09.2012 - 02.2013
Provider Resolution Specialist; Business Analyst; Call Center Supervisor
Blue Cross Blue Shield of South Carolina
08.2010 - 09.2012
No Degree - Early Childhood Development
University Of South Carolina - Columbia
08.2006 - 05.2008
High School Diploma -
Ridge View High School
08.2002 - 05.2006
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