SARENA GILMORE
Temple,TX
Summary
Committed and identifying leverage in growth with a proven ability to build effective teams. I'm an individual who is enthusiastic and capable of working with both teams and independently.
Overview
11
11
years of professional experience
Work History
Psychiatric Nursing Assistant
Waco Center For Youth
01.2023 - 07.2024
- Participated in peer review processes to continually improve the quality of care provided within the psychiatric nursing assistant role.
- Provided crisis intervention services when necessary, de-escalating volatile situations while prioritizing patient safety at all times.
- Improved patient outcomes by collaborating with multidisciplinary teams to develop and implement individualized care plans.
- Coordinated effectively with family members to ensure they were well-informed about their loved one''s progress throughout treatment processes.
Customer Service Representative
Blue Cross Blue Shield of Texas
06.2021 - 12.2021
- Answers questions and resolves issues based on phone calls/letters from members, providers, and plan sponsors
- Provide excellent customer services for high volume in bound provider calls for the Claims Inquiry/Claims Research team
- Extensive claims research on multiple platforms to assist providers with payment questions
- Provides the customer with related information to answer the unasked questions, e.g
- Additional plan details, benefit plan details, member self-service tools, etc
- Uses customer service threshold framework to make financial decisions to resolve member issues
- Explains member's rights and responsibilities in accordance with contract
- Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target system
- Educates & assists providers on our self-service options
- Assists providers with credentialing and re-credentialing and contracting questions and issues
- Assists in compiling claim data for customer audits
- Determines medical necessity, applicable coverage provisions and verifies member plan eligibility relating to incoming correspondence and internal referrals
- Offered detailed plan explanations for Medicare Part D, increasing plan enrollments during the open enrollment period
- Created data-driven reports for Medicare beneficiaries, which were later used in strategic planning to optimize region-specific marketing
- Guided clients through Medicare transition periods, maintaining an on-time service rate
- Assisted clients through complex Medicare Part D appeals processes, maintaining a high success rate of approvals
- Resolved complex Medicare claims issues for over clients per week, achieving a accuracy rate in appeals processing
- Negotiated solution paths between customers and providers, resolving disputes regarding service authorizations and claims processing within timeframe
- Connect with customers via phone/email/chat/and or social media to resolve their questions or concerns
- Calmly attempt to resolve and de-escalate any issues
- Escalate interactions when necessary and appropriate
- Respond to requests for assistance and/or possible processing payments
- Track all call related information for auditing and reporting purposes
- Provide feedback on call issues
- Upsell if required
Customer Service Representative
American Income Life Insurance Company (remote)
11.2017 - 08.2020
- Provides the right experience to customers for billing, repair, retention and sales inquiries or interactions
- Troubleshoots and resolves technical problems and other general account inquiries in a single customer interaction to create promoters and enhance the customer experience
- Follows established troubleshooting procedures, including use of appropriate resources and desktop tools
- Produces work order according to established business rules
- Effectively works to build a consultative relationship with the customer to create understanding and resolve all issues
- Sets clear expectations by providing accurate information and transparent communication
- Communicates and explains account information to the customer with focus on doing everything in your power to resolve an issue while instilling confidence and trust
- When appropriate, follows established escalation procedures to expedite prompt resolution
- Illustrates competencies of a technology enthusiast
- Uses multiple tools and systems with ease (billing systems, knowledge base, technical tools etc.) to apply information to any customer interaction
- Assist customers to self-guided resolution while illustrating genuine concern and words that work throughout the interaction
- Takes a consultative approach to finding custom solutions to customers' needs
- Resolves customer complaints/concerns through active listening, empathy, professionalism and problem solving
- Improves customer satisfaction and maximize sales and retention opportunities using up-to-date knowledge of competitive environment, products and services
- Based on the customers wants and needs, acts as a product consultant, articulating appropriate product solutions, features and benefits
- Asks probing questions and does not discuss confidential contractual billing information with unauthorized persons
- Complies with all established credit policies and guidelines
- Achieves established goals and performance metrics
- Actively participates in trainings and coaching sessions
- Interacts with customers through various means of communication (both verbal and written) to assist with a variety of customer inquiries and issues
- Must be able to wear telephone headset and manipulate objects such as pen, keyboard and mouse
- Consistently follows company policies, quality guidelines and procedures while applying sound judgment within scope of empowerment and follows guidelines for Customer Proprietary Network Information (CPNI) and Personal Identifiable Information (PII)
- Regular, consistent and punctual attendance
- Must be able to work nights and weekends, variable schedule(s) and overtime as necessary
- Other duties and responsibilities as assigned
CSR (Remote)
General Dynamics
06.2015 - 10.2017
- Carried out first-level core troubleshooting on software system issues and provided precise technical solutions
- Quickly build positive working relationships with customers and other professionals, such as software developers
- Responding to call-outs within agreed-upon time frames
- Serve as a front-line customer interface, accepting trouble reports in the Network Monitoring Center
- Work on a task until it is completed (or referred to third parties, if necessary)
- Handled critical issues by referring user issues to senior analysts, specialists, supervisors, or other support groups when additional assistance was required
- Installing and configuring operating systems and applications on computer hardware
- Upsell current customers on new or enhanced services
- Assist customers with issues and concerns they are experiencing during the use of the product and/or service
- Document call-related information for auditing and reporting purposes
- Maintain and update customer information as necessary
Behavioral Tech
Daybreak Community Services
09.2013 - 06.2016
- Maintained accurate data collection on client progress, enabling effective analysis and modification of treatment plans as needed.
- Reduced problem behaviors by teaching clients appropriate coping strategies and replacement behaviors.
- Promoted a safe and nurturing environment for clients, ensuring their comfort and well-being throughout therapy sessions.
- Adapted therapy materials based on individual needs, ensuring accessibility for all clients regardless of ability level or learning style.
Education
Associate of Science - Healthcare Administration
McLennan Community College
Waco, TX12-2024
Skills
- Professional boundaries
- Self-awareness
- Group therapy facilitation
- Individualized care planning
Timeline
Psychiatric Nursing Assistant
Waco Center For Youth
01.2023 - 07.2024
Customer Service Representative
Blue Cross Blue Shield of Texas
06.2021 - 12.2021
Customer Service Representative
American Income Life Insurance Company (remote)
11.2017 - 08.2020
CSR (Remote)
General Dynamics
06.2015 - 10.2017
Behavioral Tech
Daybreak Community Services
09.2013 - 06.2016
Associate of Science - Healthcare Administration
McLennan Community College
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