Tara Keliiheleua

Work History

Health Net Federal Services LLC

10.2021 - 01.2025

Lead of Case/Care Management Department (IPUM)
Performed post-discharge follow-up, including locating available providers, under the direction of the care manager
Completed monthly audits of all Case/Care Support members including data entry and inbound phone calls
Collected, compiled, and analyzed data and information for inclusion in reports
Prepared and presented charts, graphs, or tables, as necessary
Provided training, coaching, and mentoring of new team members in all systems, including AWS, DOMA, Omni, and Care Radius
Extensive Data Entry, Charting, and Clinical document attachment

State of HI DOL/State of AZ DOL

09.2020 - 10.2021

Evaluated pending claims to identify and resolve problems blocking auto-adjudication
Inputted data into the system, maintaining accuracy of provider coding information and reported services
Reviewed administrative guidelines whenever questions arose during processing of claims
Documented file notes clearly and concisely in DOL programs
Administered standard contract benefits to process pending claims for unemployment benefits
Delivered exceptional customer service to clients by communicating information and actively listening to concerns
Reviewed policies to determine appropriate levels of coverage and assist with approval or denial decisions
Investigated potentially fraudulent claims with focus on thoroughness, quality, and cost control
Analyzed information gathered by investigations and reported findings and recommendations

Republic Services

10.2018 - 12.2019

Demonstrated leadership by making improvements to work processes and helping to train others
Prioritized and organized tasks to efficiently accomplish service goals
Identified needs of customers promptly and efficiently
Assisted with customer requests and answered questions to improve satisfaction
High volume frontline customer support in scheduling deliveries and pickups of trash containers and dumpsters
Assisted with account and billing issues
Coordination of contract requirements for customers to review and return

Lancer Orthodontics

06.2018 - 10.2018

Presented orthodontic products and services to prospective customers
Penetrated new markets by investigating competitor products, services, and trends
Discovered sales opportunities by showcasing orthodontic products and services to interested clients
Prospected, identified and cultivated relationships with contacts to promote product lines and solutions
Managed expenses and time to maximize productivity
Attended industry functions to learn more and share knowledge with orthodontists to further grow the customer base

OC Orthodontics

02.2015 - 06.2018

Answered customers' questions and addressed complaints by phone to immediately rectify issues
Provided support for all 7 company territory managers and their customer base
Managed precise orthodontic supply orders for hundreds of offices across the US
Coached, monitored, and motivated new agents to boost performance and enhance job knowledge
Processed customer account changes with proprietary software
Managed key account service, providing exceptional support to foster loyalty and retention
Engaged in conversation with customers to understand needs, resolve issues, and answer product questions
Kept records of customer interactions or transactions, thoroughly recording details of inquiries
Supported sales team members to drive growth and development
Collected deposits or payments and arranged for billing