Tahaira Lewis
Milwaukee,WI
Summary
Results-driven professional with extensive experience in Medicare policies and procedures, dedicated to delivering accurate and timely assistance to customers. Strong communication skills facilitate the resolution of inquiries while providing clear and concise information. Proven ability to enhance customer satisfaction through effective problem-solving and a commitment to service excellence. Adept at navigating complex situations to ensure optimal outcomes for clients.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Healthcare Customer Service Representative
Outreach Community Centers
06.2021 - 09.2025
- Handle 50–70 inbound calls daily assisting members with claims status, benefits coverage, and provider network inquiries.
- Process and route medical and pharmacy claims according to plan policies.
- Provide accurate benefit explanations and educate members on plan utilization and preventive services.
- Document interactions in CRM systems ensuring compliance with HIPAA and quality standards.
- Collaborate with claims adjusters and care coordinators to resolve escalated member concerns efficiently.
- Achieved 95% customer satisfaction and exceeded call resolution metrics.
- Resolved complex customer inquiries regarding health insurance policies and claims processing.
- Trained new team members on software systems and customer service best practices.
- Resolved customer inquiries efficiently, ensuring high satisfaction levels and timely follow-ups.
- Coordinated appointments and managed scheduling for healthcare services, optimizing patient flow.
- Assisted customers in navigating Medicare options, ensuring clarity and understanding of benefits.
- Resolved complex inquiries regarding claims processing and coverage eligibility efficiently.
- Reduced call handling time with efficient problem-solving skills and comprehensive knowledge of Medicare policies and procedures.
- Established trust among customers by demonstrating empathy during challenging situations, providing reassurance, and offering expert guidance on available resources.
Medicare Customer Service Representative
TTEC
03.2018 - 05.2021
- Managed front-office operations including patient registration, insurance verification, scheduling, and medical record management.
- Assisted patients with referrals, prior authorizations, and understanding copayments or coverage.
- Supported care coordination by ensuring timely follow-up for chronic care patients and specialist appointments.
- Worked closely with nurses and providers to improve patient flow and communication.
- Recognized by management for maintaining high professionalism and empathy under pressure.
- Coordinated patient scheduling and follow-up to enhance appointment adherence.
- Managed electronic health records management to ensure accurate patient information access.
- Coordinated patient scheduling to optimize clinic workflow and minimize wait times.
- Managed electronic health records, ensuring accuracy and compliance with regulations.
- Facilitated Medicare enrollment processes, ensuring compliance with regulations and policies.
- Educated beneficiaries on plan options, benefits, and eligibility requirements to enhance understanding.
- Coordinated outreach initiatives to increase awareness and drive enrollment in Medicare programs.
Medicare Customer Service Representative
Concentrix
01.2015 - 02.2018
- Delivered exceptional customer support for inbound and outbound calls across multiple industries, including healthcare accounts.
- De-escalated challenging situations with patience and active listening.
- Consistently exceeded call quality and accuracy benchmarks.
- Resolved customer inquiries efficiently, ensuring high satisfaction levels.
- Assisted in training new representatives on call handling procedures and systems.
- Resolved customer inquiries through effective communication and problem-solving techniques.
- Managed high-volume calls, ensuring prompt and accurate service delivery.
- Educated beneficiaries on available programs, enhancing overall customer satisfaction and retention.
- Collaborated with cross-functional teams to streamline service processes, improving response times.
- Implemented feedback mechanisms to gather customer insights for continuous service improvement.
- Trained new representatives on systems and best practices, fostering a knowledgeable workforce.
- Monitored compliance with regulations, ensuring adherence to Medicare guidelines and policies.
- Analyzed customer interactions to identify trends, recommending strategic enhancements for service delivery.
Education
Associate Degree - Health Administration
Milwaukee Area Technical College
Milwaukee, WI05-2029
Skills
- Healthcare Customer Service
- Claims Processing & Follow-Up
- Member Eligibility & Benefits Verification
- Patient Scheduling & Coordination
- Insurance Billing & Adjustments
- Medical Terminology & EMR Systems (Epic, Cerner, etc)
- Prior Authorizations & Referrals
- HIPAA Compliance
- Call Center & Case Management Support
- Problem Solving & Conflict Resolution
- Proficient with: Epic, Avaya, Salesforce, Microsoft Office Suite, Facets
- Strong verbal and written communication skills
- Passionate about improving patient experiences and access to care
- HIPAA compliance
- Insurance verification
- Appointment scheduling
- Patient confidentiality
- Medical terminology
- Medicare
Certification
- HIPAA Compliance Training (current)
- Customer Service Excellence Certificate – 2024
- Basic Life Support (BLS), American Heart Association (optional if applicable)
Timeline
Healthcare Customer Service Representative
Outreach Community Centers
06.2021 - 09.2025
Medicare Customer Service Representative
TTEC
03.2018 - 05.2021
Medicare Customer Service Representative
Concentrix
01.2015 - 02.2018
Associate Degree - Health Administration
Milwaukee Area Technical College