Taylor Miller
Foley,United States
Summary
Reliable and results-driven customer service professional with a proven track record in quality assurance, healthcare support, seniorlevel escalation resolution, and team collaboration. Skilled at balancing empathy with efficiency while navigating complex systems such as pharmacy benefits, claims processing, and HIPAA compliance. Known for maintaining high QA scores, resolving advanced escalations, coaching peers toward success, and delivering exceptional service in both call center and face-to-face environments. Adept at streamlining workflows, identifying process gaps, and turning feedback into actionable improvements. Adept at vendor coordination, workflow optimization, and delivering high-quality service in both clinical and business environments. Passionate about supporting others and making a positive impact in fast-paced, people-focused roles.
Overview
4
4
years of professional experience
Work History
Senior Resolution Specialist
Everise
01.2025 - Current
- Served as an escalation point for complex or unresolved member issues, ensuring fast and accurate resolutions.
- Handled high-priority cases involving claims disputes, medication overrides, prior authorization escalations, and benefit clarification.
- Collaborated with internal departments - including PBM teams, pharmacists, QA and supervisors - to resolve multi-step issues.
- Delivered clear explanations of benefits, processes, and outcomes to members, pharmacies and providers.
- Improved customer satisfaction and reduced repeat calls by identifying root causes and providing thorough resolutions.
Quality Assurance Analyst
Everise
09.2023 - 01.2025
- Trained and onboarded new employees on QA processes.
- Monitored workflows and evaluated live/recorded calls for compliance and service expectations.
- Provided detailed feedback and coaching to agents.
- Generated quality reports and documented findings in Verint and SharePoint.
- Scored agent interactions for accuracy, HIPAA, and resolution quality.
Customer Service Representative
Continuum Global Solutions/Everise
11.2021 - 09.2023
- Handled 70+ daily inbound calls related to prescription coverage, claims, co-pays, and eligibility.
- Resolved escalated prior authorization issues by coordinating with pharmacists and PBM teams.
- Maintained a 98%+ QA score and consistently exceeded performance targets.
- Assisted members with benefits verification and claim inquiries.
- Supported pharmacy networks in expediting prescription fills and resolving COB cases.
Education
Highschool -
ROBERTSDALE HIGHSCHOOL
ALSterile Processing Technician -
HEALTH TECH ACADEMY
Skills
- Patient & Customer Support
- Call Center Operations
- Conflict Resolution Specialist & Problem Solving
- Healthcare Administration
- Insurance Verification & Claims Support
- Electronic Medical Records (EMR)
- HIPAA Compliance
- Appointment Scheduling
- Vendor & Supply Coordination
- Communication & Interpersonal Skills
- Multi-line Phone Systems
- Time Management & Prioritization
- Data Entry & Documentation
- Performance Monitoring & Coaching
- Adaptability in Fast-Paced Environments
- Multi-System navigation (PBM, Claims, Eligibility, Pharmacy Platforms)
Accomplishments
- QA of the month - NOV2023, OCT2024, NOV2025
- Delivered exceptional customer service, increasing client retention and referrals.
- Trained and onboarded 4+ agents for QA.
- Maintained 95%+ customer satisfaction by effectively resolving inquiries.
- Ensured HIPAA compliance and supported EMR system implementation.
- Resolving billing and insurance issues to accelerate reimbursement.
Timeline
Senior Resolution Specialist
Everise
01.2025 - Current
Quality Assurance Analyst
Everise
09.2023 - 01.2025
Customer Service Representative
Continuum Global Solutions/Everise
11.2021 - 09.2023
Highschool -
ROBERTSDALE HIGHSCHOOL
Sterile Processing Technician -
HEALTH TECH ACADEMY