Summary
Overview
Work History
Education
Skills
Timeline
Generic

Sequoia Harden

Sacramento,CA

Summary

Highly skilled call center professional with extensive experience in assisting members with health benefits inquiries and ensuring exceptional customer service. Proficient in registering new members, managing profiles, and submitting accurate demographic information. Adept at handling high call volumes, consistently aiming for first call resolution. Knowledgeable in eligibility requirements and plan information for PPO, HMO, and EPO insurances.

Overview

9
9
years of professional experience

Work History

Customer Care Clerk

Delta Dental, Wollborg Michelson
09.2023 - Current
  • Answered inbound calls averaging 30-40+ calls daily
  • Explained health benefits to members and assisted with inquiries
  • Send follow up emails to patients and providers
  • Payments
  • Provided portal support for providers and patients
  • Assisted with provider credentialing
  • Provided guidelines for compliance
  • Increased efficiency by streamlining filing systems and organizing important documents.
  • Improved customer satisfaction by promptly answering inquiries and providing accurate information.
  • Collaborated with team members to complete tasks efficiently and meet deadlines.
  • Maintained professional atmosphere within office setting through effective communication skills and polished presentation abilities.
  • Ensured confidentiality of sensitive documents through proper storage methods and restricted access control implementation.
  • Utilized strong multitasking skills to manage multiple priorities and tasks, ensuring timely completion of each assignment.
  • Reduced claim errors by carefully reviewing documentation and verifying information before submission.
  • Collaborated with adjusters and investigators to gather necessary information for efficient claim resolution Assisted customers in understanding claims process, providing clear explanations of procedures and requirements.

Member Care Representative

United HealthCare, RDI
10.2021 - 06.2023
  • Call Center
  • Answered inbound calls averaging 30-40+ calls daily
  • Explained health benefits to members and assisted with inquiries
  • Registered new members, created profiles, and submitted demographic information
  • Send follow up emails to patients and providers
  • Follow all Adherence Guidelines.
  • Enhanced provider satisfaction by addressing and resolving inquiries in timely manner.
  • Assisted providers in navigating through various reimbursement processes, resulting in timely payments and reduced financial disputes between parties.
  • Answered provider inquiries via email, telephone and written correspondence.
  • Followed document protocols to safeguard confidentiality of patient records.
  • Streamlined processes for provider credentialing, ensuring accurate documentation and faster on boarding.

Customer Service Representative

Covered California, Faneuil
11.2014 - 12.2019
  • Answered inbound calls averaging 30-80+ calls daily
  • Assisted with inquiries
  • And aimed for first call resolution
  • Entered demographic information in insurance applications
  • Reviewed eligibility requirements based on income
  • Reviewed plan information for PPO, EPO, and HMO insurances
  • Submitted enrollment for Qualified Health Plans (QHP)
  • Verified uploaded documents including Income, citizenship, supporting documents, etc
  • Documented all calls in CRM system
  • Adhered to all HIPAA and adherence guidelines
  • Provided information regarding Medi-Cal/Covered CA guidelines
  • Discussed and reviewed Federal Poverty Level (FPL) data with customers.
  • Handled escalated calls efficiently, finding satisfactory resolutions for both customers and company alike.
  • Implemented feedback loops that encouraged continuous improvement among team members by sharing insights about exceptional service delivery techniques.
  • Handled customer inquiries and suggestions courteously and professionally.
  • Answered constant flow of customer calls with minimal wait times.
  • Clarified customer issues and determined root cause of problems to resolve product or service complaints.

Education

High School Diploma -

Cordova Adult School
Rancho Cordova, CA

Skills

  • Call Center
  • Open Enrollment
  • Referrals
  • Scheduling
  • Insurance Benefits
  • EPO, HMO, PPO
  • Claims
  • HIPAA Compliance
  • Microsoft
  • Electronic Health Records
  • Epic
  • Salesforce
  • Ring Central
  • Citrix
  • CRM Software

Timeline

Customer Care Clerk

Delta Dental, Wollborg Michelson
09.2023 - Current

Member Care Representative

United HealthCare, RDI
10.2021 - 06.2023

Customer Service Representative

Covered California, Faneuil
11.2014 - 12.2019

High School Diploma -

Cordova Adult School

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Sequoia Harden