Shemika Stuart

• Oversaw daily operations of the department, ensuring smooth workflow and timely completion of tasks.
• Applied strong leadership talents and problem-solving skills to maintain team efficiency and organize workflows.
• Handled customer complaints, resolved issues, and adjusted policies to meet changing needs.
• Monitored workflow to improve employee time management and increase productivity.
• Evaluated employee performance and coached and trained to improve weak areas.
• Increased team productivity by implementing efficient workflows and setting clear expectations for staff members.

Conduct Inbound and Outbound calls to members regarding programs and upcoming appointments. Schedule In home or Telehealth visits with provided Nurse. Utilize multiple screens while following formal script to accept inbound calls from healthcare providers and clients.

Investigate and evaluate claims, negotiate settlements with claimants, and ensure all claims are handled accurately and efficiently. Processing and reporting claims by researching the policy and accumulating evidence regarding claims.

Scheduling appointments.

Resolve all customer inquiries regarding claims for deductible reimbursement. Investigate all missing medication shipments and follow up with claimant. Provide settlements and appeal decisions to all claimants.

• Enhanced user experience by providing comprehensive troubleshooting guidance for various software and hardware systems.
• Improved customer satisfaction by addressing and resolving technical issues swiftly and efficiently.
• Managed high-priority tickets with professionalism, ensuring timely resolutions while maintaining excellent rapport with clients.
• Broke down and evaluated user problems, using test scripts, personal expertise, and probing questions.