Summary
Overview
Work History
Education
Skills
Certification
LANGUAGES
Work Availability
Timeline
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SHI CAIN

SHI CAIN

Lake Charles,LA

Summary

Dynamic professional with strong problem-solving abilities, a keen willingness to learn, and exceptional communication skills. Committed to contributing to team success and driving positive results through collaboration and innovative thinking. Eager to embrace new challenges while advancing organizational objectives with unwavering dedication and enthusiasm. A proactive approach ensures readiness to adapt and thrive in fast-paced environments.

Overview

13
13
years of professional experience
1
1
Certification

Work History

Customer Service Agent

Pets Best Insurance / Temp
01.2025 - 08.2025
  • Processed policy management tasks including new user registrations, coverage adjustments, and policy terminations for approx 30 to 65 accounts daily.
  • Managed and escalated claims inquiries for medical cases monthly, ensuring timely resolutions and reducing response times by 30%.
  • Coordinated internal communications and technical support for policy holders enabling streamlined member navigation and account management.

Client Care Specialist

Humana
10.2022 - 12.2024
  • Address inquiries via phone and digital channels, ensuring client satisfaction by reducing TAT by three days.
  • PCP and Specialist referrals, scheduling, and demographic changes.
  • Prior Authorization request for medical and retail pharmacies.
  • Pharmacy tech assistance supporting medicaid/medicare patients to understand their behavioral health benefits, OPS, onboarding, medical billing inquiries etc.

Patient Access Representative

Ochsner Medical
11.2017 - 03.2021
  • Coordinate patient inquiries and scheduling: vaccines, OPS, PCP, medical billing inquiries, etc.
  • Facilitate communication among medical staff utilizing medical terminology to accurately address patient needs.
  • Followed strict HIPAA and state privacy guidelines while reviewing patient records to provide informed responses.
  • Enhance patient satisfaction through effective, empathetic and resourceful communication aiming to maintain 90% ratings.
  • Manage complex scheduling systems.
  • Accurately input patient data to uphold high standards of healthcare administration.

Applecare Advisor

Apple Inc.
10.2012 - 04.2016
  • Resolving complex issues enhancing the user experience.
  • Analyzed customer inquiries to identify trends, collaborating with product teams to maintain a service average of 89%.
  • Technical support level 3 problemsolving, streamlining troubleshooting processes and reducing resolution time.
  • Fostered strong relationships within support teams, sharing knowledge and best practices to elevate overall service quality.
  • Product sales and upgrades
  • Device setup assistance and data synchronization support

Education

Certification - Medical Billing & Coding

Louisiana State University Eunice
12-2024

Skills

  • CPC
  • CRM
  • Google applications
  • HIPAA
  • Medical claims
  • Mac OSx
  • Prior Authorizations
  • Medical Insurance
  • Salesforce
  • Patient Navigator
  • Healthcare enrollment
  • Technical Support III
  • Billing/ Coding
  • Pharmacy Tech Assist
  • Appeals
  • Grievances
  • Analytical thinking

Certification

  • Louisiana University of Eunice
  • Medical Billing & Coding
  • 2025-10 - 2025-12

LANGUAGES

English (fluent)

Work Availability

monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Timeline

Customer Service Agent

Pets Best Insurance / Temp
01.2025 - 08.2025

Client Care Specialist

Humana
10.2022 - 12.2024

Patient Access Representative

Ochsner Medical
11.2017 - 03.2021

Applecare Advisor

Apple Inc.
10.2012 - 04.2016

Certification - Medical Billing & Coding

Louisiana State University Eunice

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