Summary
Overview
Work History
Education
Skills
Accomplishments
Professional Development
Timeline
Generic

Sarah O'Keefe

Tolland

Summary

Professional with strong background in managing and resolving customer complaints. Skilled in conflict resolution, communication, and problem-solving, ensuring customer satisfaction and loyalty. Known for effective teamwork, adaptability, and delivering consistent results in fast-paced environments. Reliable and ready to contribute to collaborative team focused on achieving organizational goals.

Overview

26
26
years of professional experience

Work History

Appeals Complaint Coordinator, Medicare Part C

Aetna Inc.
01.2021 - Current
  • Research and resolves incoming electronic appeals as appropriate as a 'single-point-of-contact' based on type of appeal.
  • Can identify and reroute inappropriate work items that do not meet complaint/appeal criteria as well as identify trends in misrouted work.
  • Assemble all data used in making denial determinations and can act as subject matter expert with regards to unit workflows, fiduciary responsibility and appeals processes and procedures.
  • Research standard plan design, certification of coverage and potential contractual deviations to determine the accuracy and appropriateness of a benefit/administrative denial.
  • Can review a clinical determination and understand rationale for decision.
  • Able to research claim processing logic and various systems to verify accuracy of claim payment, member eligibility data, billing/payment status, and prior to initiation of the appeal process.

Customer Service Consultant, Medicare MSO Helpdesk

Aetna Inc.
01.2017 - 01.2021
  • Handles and assists internal CSR with questions and inquiries regarding Medicare benefits and how claims are being processed.
  • Reviewing policy and weekly updates to ensure all claims are being processed and paid correctly.
  • Properly reworking and keying claims in for members when needed.
  • Following and complying with required phone and production quality goals.

Senior Customer Service Representative, Corporate Contact Center

Aetna Inc.
01.1999 - 01.2017
  • Handle customer service inquiries and problems via telephone, internet, or written correspondence.
  • Handle non-routine calls that require deviation from standard screens, scripts, and procedures.
  • Act as a subject matter expert by providing training, coaching, or responding to complex issues.
  • Proficient of the switchboard ACD Call Center System, MSW (Member Service Workbench), CCI (Coverage Card Inquiry), PHC (Prudential Health Care System) HMO (Health Maintenance Organizations), ADA (Aetna Directory Assistance), ASD (Aetna Strategic Desktop).
  • Research and respond to incoming inquiries to Aetna's Corporate Mailbox.
  • Assisting members with the registration and technical issues regarding Aetna's Navigator system.

Education

High School Diploma -

Rockville High School
Vernon, CT
06-1996

Skills

  • Complaint handling
  • Follow-up skills
  • Assertiveness
  • Microsoft office
  • Customer service
  • Problem-solving skills
  • Time management
  • Attention to detail
  • Multitasking Abilities
  • Calm and professional under pressure
  • Excellent communication
  • Product knowledge
  • Medical terminology
  • Continuous improvement

Accomplishments

  • Adheres to Quality & Production goals
  • Strong sense of customer focused service within a metrics driven environment

Professional Development

  • Fraud Awareness Courses
  • Compliance Practices
  • Ethics Training
  • Comprehensive Customer Service training through the Aetna Learning Center
  • Call Center Management and Customer Service Seminars

Timeline

Appeals Complaint Coordinator, Medicare Part C

Aetna Inc.
01.2021 - Current

Customer Service Consultant, Medicare MSO Helpdesk

Aetna Inc.
01.2017 - 01.2021

Senior Customer Service Representative, Corporate Contact Center

Aetna Inc.
01.1999 - 01.2017

High School Diploma -

Rockville High School

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