Summary
Overview
Work History
Education
Timeline
Generic

Sunjanetta Green

Las Vegas,NV

Summary

To utilize my communication and customers service skills to achieve company's goal that focus on customer satisfaction and experience

Overview

10
10
years of professional experience

Work History

Contracted Customer Care Advocate

Centene Corporation
11.2023 - 03.2024
  • Answer incoming healthcare contact center calls and route appropriately to clinical staff
  • Gather and verify demographic information and document calls using standard computer software and systems
  • Use tools and apply problem-solving skills to identify immediate caller needs, including potential crisis calls; escalate crisis calls according to standard operating procedures
  • Use verbal communication strategies to effectively elicit information, gain confidence from caller and provide reassurance
  • Answer inbound call and make outbound calls according to department policies and procedures
  • Use active listening skills and interviewing techniques to accurately identify caller's presenting concerns
  • Identify and employ alternative approaches to communicate with callers when encountering barriers
  • Handling 20-40 calls a day depending on call volume.

Health Program Representative

Anthem Blue Cross and Blue Shield
09.2022 - 11.2023
  • Gathers and records appropriate member information in accordance with policies and procedures via telephone
  • Encourages members to participate in the Care Management programs by providing information about the program, outlining program features/value and explaining available services
  • Records call details and utilize call scripts as needed based on client requirements
  • Directs member inquiries to appropriate clinical staff
  • Initiates referrals and manages consults from clinicians for participants registered in Care Management
  • Gathers information from hospitals, health plans, physicians, patients, vendors and other referral sources
  • Contacts physician offices to obtain demographic information or related data as needed.

Contracted Employee Benefits Advisor

Gallagher
08.2019 - 09.2022
  • Reviews client member benefit options and provides guidance to ensure client members are optimizing the use of their employee benefits
  • Collaborates with insurance carriers, providers, and third party administrators to resolve claim and eligibility concerns for client members, providing resolution expertise and any other assistance and/or support requested or required by the client
  • Advocates negotiate on behalf of the client members as necessary to assist with eligibility, claim and benefit issues or any question or concern, and maintaining clear and accurate records and updating open issues by logging into a secure database
  • Responsible for the servicing of existing clients-identifying and assessing customer needs to achieve satisfaction
  • Receives and responds to client member inquiries both written and verbal
  • Follows-up on client member issues, researches problems and processes documents necessary to ensure a successful resolution
  • Handles calls and correspondence that are predominantly routine but may require some deviation from standard procedures.

Licensed Medicare Sales Agent

Teleperformance
10.2020 - 08.2021
  • Handle and carefully respond to all inbound and outbound customer inquiries
  • Provide excellent customer service through active listening
  • Work with confidential customer information and treat it sensitively
  • Aim to resolve issues on the first call by being proactive, patient, empathetic, and understanding
  • Appropriately communicate with customers, exercising retention efforts if needed
  • Identify customers who are comparison-shopping and inquiring about contract terms, assisting the customer with the correct price plan
  • Compassionately handle sensitive situations surrounding healthcare needs, education, and prevention planning.

Contracted Office Clerk

U.S. Census Bureau
03.2020 - 09.2020
  • General office clerks perform a variety of clerical tasks, including answering telephones, typing documents, and filing records
  • General office clerks typically do the following: Answer and transfer telephone calls or take messages
  • Sort and deliver incoming mail and send outgoing mail, and conducting over the Phone Interviews.

Customer Advocate

RDI
10.2018 - 08.2019
  • SWAP communicates to the Plan Members and Providers the policies and Services of the Scott & White Health Plan (SWAP), and handles any complaints concerning the Plan
  • Customer Advocate I SWAP works on the customers behalf to resolve any issues and or concerns by going
  • To obtain benefits Information requested by member and/or Providers
  • Multitasking at a quick pace, handling inbound calls from Patients, physician offices, and/or insurance companies
  • Resolve claim rejections for eligibility, Coverage, send claims back for review
  • CD-10, CPT codes, Billing and Coding
  • Medicare, HMO and standard insurance verification processes
  • Handle's Grievance's, Complaints, and Appeals for Provider's and Member's
  • Handles Material Request, obtain prior authorization and secures co-pay as defined by policy
  • Solving very complex problems, Technical Support and following HIPAA/PHI guidelines
  • Also working closely with Optum and the Health Services Department.

Direct Support Staff

KNR Assisting Living Services
05.2014 - 10.2017
  • Assist clients in maintaining safe and healthy lifestyles
  • Carefully for changes in the clients general Health, appearance, behavior, and patterns of activities
  • Working in an Office setting sometimes.

Education

Diploma -

Clark County School District
Las Vegas, NV
10.2017

Timeline

Contracted Customer Care Advocate

Centene Corporation
11.2023 - 03.2024

Health Program Representative

Anthem Blue Cross and Blue Shield
09.2022 - 11.2023

Licensed Medicare Sales Agent

Teleperformance
10.2020 - 08.2021

Contracted Office Clerk

U.S. Census Bureau
03.2020 - 09.2020

Contracted Employee Benefits Advisor

Gallagher
08.2019 - 09.2022

Customer Advocate

RDI
10.2018 - 08.2019

Direct Support Staff

KNR Assisting Living Services
05.2014 - 10.2017

Diploma -

Clark County School District

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Sunjanetta Green