Shakina Everett
Lakeland,FL
Summary
Results-driven individual with a solid track record in delivering quality work. Known for excellent communication and teamwork abilities, with a commitment to achieving company goals and delivering exceptional service. Passionate about continuous learning and professional development.
Overview
12
12
years of professional experience
Work History
Precertification Specialist
Managed Staffing
03.2024 - Current
- Collaborated with customer services, benefits verification and pharmacy operations teams to communicate referral status and determinations for Aetna/CVS Specialty Pharmacy
- Processed coverage requests from providers via fax and email and ensured timely and accurate responses
- Conducted outreach to patients and providers, identified and corrected issues and met established timelines
Customer Service Representative II
Centene Corporation
07.2022 - 05.2023
- Enhanced productivity by anticipating needs and delivered outstanding support
- Managed and resolved escalated and complex inquiries regarding claims, eligibility, benefits and prior authorization while maintaining professionalism
- Guided members through troubleshooting and navigating the Ambetter Health website and mobile app
- Processed customer service requests via phone support, ensuring HIPAA compliance
- Provided first call resolution by collaborating with appropriate internal/external resources
Virtual Medical Scribe
Nuance Communications
07.2021 - 07.2022
- Collaborated in real time with medical teams to summarize and complete confidential medical documentation
- Ensured HIPAA compliance by maintaining confidentiality in handling sensitive information
- Delivered accurate documentation promptly to enhance patient care
Human Services Program Specialist
Agency for Healthcare Administration
Orlando, FL
05.2016 - 06.2021
- Acted as a subject matter expert for Florida Medicaid recipients
- Documented customer correspondence in CRM to track requests, problems and solutions
- Trained new employees in customer service processes and provided feedback for program improvements
- Assisted in resolving complex customer issues and implementing targeted solutions
Member Services Representative
Catamaran, Inc.
Orlando, FL
02.2015 - 03.2016
- Delivered exceptional by leveraging extensive product and service knowledge
- Assisted pharmacists with processing claims and promoted products and services
- Responded promptly to customer inquiries with high energy and professionalism
Employment Security Representative
Faneuil Inc.
Orlando, FL
03.2013 - 02.2015
- Managed inbound/outbound calls related to unemployment assistance claims
- Conducted interviews with claimants regarding reporting errors and processed reports of unemployment assistance fraud
- Met and exceeded productivity goals while maintaining high customer satisfaction
Skills
- Zendesk
- Salesforce
- Microsoft Office Suite
- Google Suite
- Slack
- Data Analysis
- Prior authorization
- Conflict Resolution
Timeline
Precertification Specialist
Managed Staffing
03.2024 - Current
Customer Service Representative II
Centene Corporation
07.2022 - 05.2023
Virtual Medical Scribe
Nuance Communications
07.2021 - 07.2022
Human Services Program Specialist
Agency for Healthcare Administration
05.2016 - 06.2021
Member Services Representative
Catamaran, Inc.
02.2015 - 03.2016
Employment Security Representative
Faneuil Inc.
03.2013 - 02.2015
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