Summary
Overview
Work History
Education
Skills
Timeline
Generic

Shayla Winston

Richmond,VA

Summary

Knowledgeable and dedicated customer service professional with extensive experience in the healthcare industry. Solid team player with outgoing, positive demeanor and proven skills in establishing rapport with clients. Motivated to maintain customer satisfaction and contribute to company success. Specialize in quality, speed and process optimization. Articulate, energetic and results-oriented with exemplary passion for developing relationships, cultivating partnerships and growing businesses.

Overview

10
10
years of professional experience

Work History

Member Service Representative

Anthem
10.2019 - Current
  • Achieved high performance evaluations for call handling ability and quality of services provided to patients in a fast paced, high volume call center
  • Responded to customer questions via telephone and written correspondence regarding insurance benefits, provider contracts, eligibility and claims
  • Developed and maintained positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.
  • Established trust with clients by accurately addressing their concerns and offering appropriate resolutions based on their needs.
  • Exceeded monthly performance metrics consistently, contributing to the success of the call center operations.
  • Enhanced customer satisfaction by efficiently addressing and resolving inquiries in a timely manner.
  • Investigated and resolved accounting, service and delivery concerns.
  • Used critical thinking to break down problems, evaluate solutions and make decisions.

Enrollment Specialist

Conduent
03.2019 - 06.2019
  • Determined financial needs by assessing existing coverage and aligning new products and services with long-term goals.
  • Updated, entered, and reviewed customer data.
  • Enhanced team productivity through effective time management and prioritization techniques during peak enrollment periods.
  • Acted as a team leader in group projects, delegating tasks and providing feedback.
  • Paid attention to detail while completing assignments.
  • Self-motivated, with a strong sense of personal responsibility.

Medicare/Medicaid Representative

General Dynamics
09.2016 - 03.2019
  • Gathered, organized and input information into digital database.
  • Handled customer complaints quickly and professionally to restore customer confidence and prevent loss of business.
  • Conducted company performance evaluations after events to assess interest level shown for products and services and discover opportunities for growth.
  • Cultivated positive relationships with vendors to deliver timely and cost-effective supply of services and materials.
  • Facilitated smooth transitions for policyholders during the claim process by liaising between various departments, ensuring all parties were informed and engaged.
  • Researched and analyzed policy contracts to verify proper payment of claims.
  • Verified insurance claims and determined fair amount for settlement.
  • Analyzed information gathered by investigation and reported findings and recommendations.
  • Determined liability outlined in coverage and assessed documentation such from police and healthcare providers to understand damages incurred.
  • Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
  • Maintained compliance with state regulatory requirements through meticulous documentation and adherence to company policies.
  • Identified potential fraud indicators early in the investigation process, protecting company assets from potential losses due to fraudulent activity.
  • Responded to customer inquiries regarding health insurance coverage and policies to assist with informed decision-making.

Assistant Manager

Charlotte Russe
07.2015 - 08.2016
  • Developed strong working relationships with staff, fostering a positive work environment.
  • Made hiring recommendations to increase company's productivity and profitability with quality workers.
  • Trained personnel in equipment maintenance and enforced participation in exercises focused on developing key skills.
  • Increased employee performance and job satisfaction to strengthen retention and engagement.
  • Strengthened merchandising and promotional strategies to drive customer engagement and boost sales.
  • Maintained positive customer relations by addressing problems head-on and implementing successful corrective actions.
  • Generated repeat business through exceptional customer service and responded to customer concerns with friendly and knowledgeable service.
  • Supervised day-to-day operations to meet performance, quality and service expectations.
  • Monitored cash intake and deposit records, increasing accuracy, and reducing discrepancies.
  • Used strong analytical and problem-solving skills to develop effective solutions for challenging situations.
  • Developed strong organizational and communication skills through coursework and volunteer activities.
  • Exercised leadership capabilities by successfully motivating and inspiring others.

Student/Receptionist

Empire Beauty Schools, Inc
02.2014 - 06.2015
  • Demonstrated thorough knowledge of all salon products and services.
  • Demonstrated proficiency in various hair styling techniques, including cutting, coloring, perming, straightening, extensions application, and updo creation.
  • Shampooed, conditioned, and rinsed guests' hair using salon-exclusive products while educating clients on product benefits to increase product sales.
  • Styled hair, makeup and nails for customers for special events and occasions.
  • Achieved a high level of customer retention through exceptional communication, time management, and problem-solving skills.
  • Organized, maintained and updated information in computer databases.
  • Supported marketing initiatives by distributing promotional materials to potential clients both online and offline channels.
  • Managed social media accounts for the salon, increasing brand awareness and attracting new clientele through engaging content creation.
  • Handled payments and processed credit card transactions.
  • Enforced spa policies, following company procedures at all times.
  • Organized and detail-oriented with a strong work ethic.
  • Excellent communication skills, both verbal and written.

Education

Bachelor of Science - Criminal Justice

Strayer University
Richmond, Va
12.2027

No Degree - Cosmetology

Empire Beauty School
Richmond, Va
06.2015

High School Diploma -

Thomas Dale High School
Chester, VA
06.2013

Skills

  • Administrative and Office Support
  • Multi-Line Phone Systems
  • Report Preparation
  • Remote Office Availability
  • Attention to Detail
  • Organizational Skills
  • Complaint Handling
  • Issue Resolution
  • De-Escalation Techniques
  • Team building
  • Medical terminology knowledge
  • Microsoft Office

Timeline

Member Service Representative

Anthem
10.2019 - Current

Enrollment Specialist

Conduent
03.2019 - 06.2019

Medicare/Medicaid Representative

General Dynamics
09.2016 - 03.2019

Assistant Manager

Charlotte Russe
07.2015 - 08.2016

Student/Receptionist

Empire Beauty Schools, Inc
02.2014 - 06.2015

Bachelor of Science - Criminal Justice

Strayer University

No Degree - Cosmetology

Empire Beauty School

High School Diploma -

Thomas Dale High School

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Shayla Winston