Shay Robinson
Converse,TX
Summary
Detail-focused individual with a strong foundation in healthcare administration and customer service. Comprehensive understanding of Medicare regulations and policies, proficiency in data management and customer support. Dedicated to ensuring clients receive optimal care and benefits through effective communication and problem-solving. Experience in insurance advising, data management, and customer service across healthcare, automotive, and administrative sectors. Skilled in HIPAA compliance, medical insurance claims, EHR systems, and healthcare policy navigation. Adept at analyzing large datasets, ensuring accuracy, and optimizing workflows to improve operations and client experiences. Currently pursuing a Bachelor of Science in Health Management, developing expertise in healthcare quality improvement, compliance, and population health management. Proficient in Microsoft Office, Google Workspace, CRM platforms, and healthcare data tools. Passionate about streamlining processes, improving patient/member advocacy, and supporting healthcare operations.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Automotive Enthusiast Advisor II
Hagerty
01.2022 - Current
- Provided expert guidance and support to automotive enthusiasts, assisting with insurance policies, vehicle valuations, and membership services
- Managed approximately 30 incoming calls, emails and faxes per day from customers.
- Delivered exceptional customer service by addressing inquiries and resolving issues related to classic and collector cars
- Educated members on Hagerty's products, including insurance coverage, Drivers Club benefits, and valuation tools
- Engaged with the car enthusiast community, fostering relationships through personalized interactions and industry knowledge
- Collaborated with internal teams to streamline processes and enhance customer experience
- Maintained a high level of industry expertise to support clients with accurate and insightful recommendations
Retention Specialist
Nationwide Mutual Insurance Company
11.2018 - 01.2022
- Managed approximately 20-40 outbound calls, emails and faxes per day from customers.
- Managed policy retention and renewal strategies, ensuring compliance with insurance regulations and customer needs.
- Assisted clients with claims processing and policy adjustments, maintaining accuracy in compliance with state and federal insurance laws.
- Provided customer education on policy coverage, claims procedures, and benefits, similar to Medicare guidelines in healthcare insurance.
- Collaborated with underwriting, claims, and legal teams to resolve disputes and ensure seamless policyholder experience.
- Handled escalated customer cases, working closely with regulatory bodies and internal teams to resolve issues efficiently.
- Utilized claims management software and CRM tools to track and manage policyholder interactions, similar to Medicare claims processing systems.
- Ensured compliance with SOX (Sarbanes-Oxley) requirements and internal financial controls, aligning with Medicare reimbursement regulations.
- Analyzed policyholder data to identify risk factors and develop retention strategies, similar to optimizing Medicare claims reimbursement.
Customer Service Representative
Centene (Superior Health Plan)
02.2016 - 09.2018
- Assisted Medicare and Medicaid members with benefits, claims, and eligibility inquiries, ensuring compliance with CMS regulations.
- Resolved Medicare-related issues, including billing discrepancies, provider coordination, and appeals.
- Educated members on Medicare Advantage Plans, coverage options, and policy updates to maximize plan utilization.
- Managed approximately 40-50 incoming calls, emails and faxes per day from customers.
- Processed claims and prior authorizations, collaborating with internal teams to ensure accurate and timely reimbursement.
- Maintained thorough documentation of all Medicare claims, interactions, and resolutions to ensure compliance with regulatory standards.
- Provided exceptional customer service by handling escalated Medicare cases and ensuring prompt resolution.
- Trained new team members on Medicare-related policies, claims processes, and compliance requirements.
- Utilized claims management software and healthcare portals to manage Medicare eligibility verification and appeals.
Administration Assistant
Trails at Leon Creek Apartments
03.2012 - 03.2016
- Provides administrative support to ensure efficient operation of the office
- Answers phone calls, schedules meetings, and supports visitors
- Carries out administrative duties such as filing, typing, copying, binding, scanning, etc
- Completes operational requirements by scheduling and assigning administrative projects and expediting work results
- Makes travel arrangements for senior staff, such as booking flights, cars, and hotel or restaurant reservations
- Exhibits polite and professional communication via phone, e-mail, and mail
- Streamlined operations and prioritized tasks, allowing senior staff to increase revenue by 25%
- Supports team by performing tasks related to organization and strong communication
- Develop administrative staff by providing information, educational opportunities, and experiential growth opportunities
- Ensures equipment operation by completing preventive maintenance requirements, calling for repairs, maintaining inventories, and evaluating new equipment and techniques
- Provides information by answering questions and requests
- Maintains supplies inventory by checking stock to determine the inventory level, anticipating needed supplies, and placing and expediting orders for supplies
- Contributes to team effort by accomplishing related results as needed
Education
BSHM - Bachelor of Science in Health Management
The University of Maryland Global Campus
Adelphi, Maryland06.2025
AAS - Health and Biosciences
San Antonio College
San Antonio, Texas01.2020
Skills
- Medicare Compliance & Law Expertise
- Medicare Claims Processing & Denial Resolution
- NGHP Recovery & Reimbursement Optimization
- Risk Identification & Data Validation
- SOX Compliance & Claims Management
- Process Improvement & Analytical Problem-Solving
- Effective Communication with Medicare Representatives
- Cross-Functional Collaboration
- Proficiency in Microsoft Office & Healthcare Analytics Tools
Certification
- Microsoft Office Specialist Certification (Excel and Word)
- AHIP Medicare Certification
- Google Analytics Certification
- CPR and First Aid Certification
- Property and Casualty License - (50 States) Department of Insurance.
- HIPAA Compliance Certification
Accomplishments
- Increased engagement and conversions by leveraging data-driven digital strategies.
- Improved reporting accuracy and process efficiency through advanced data management techniques.
- Enhanced digital content reach and effectiveness by closely analyzing audience behavior and adjusting strategies.
Timeline
Automotive Enthusiast Advisor II
Hagerty
01.2022 - Current
Retention Specialist
Nationwide Mutual Insurance Company
11.2018 - 01.2022
Customer Service Representative
Centene (Superior Health Plan)
02.2016 - 09.2018
Administration Assistant
Trails at Leon Creek Apartments
03.2012 - 03.2016
AAS - Health and Biosciences
San Antonio College
- Microsoft Office Specialist Certification (Excel and Word)
- AHIP Medicare Certification
- Google Analytics Certification
- CPR and First Aid Certification
- Property and Casualty License - (50 States) Department of Insurance.
- HIPAA Compliance Certification
BSHM - Bachelor of Science in Health Management
The University of Maryland Global Campus
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