Summary
Overview
Work History
Education
Skills
Certification
Languages
Assessments
Languages
Accomplishments
Timeline
Generic

Tiarra Butler

Hutto,USA

Summary

Innovative professional in workforce training and development, known for high productivity and efficiency in task completion. Possess specialized skills in instructional design, employee engagement strategies, and performance assessment tools. Excel using communication, adaptability, and leadership to foster learning environments that promote growth.

Overview

9
9
years of professional experience
1
1
Certification

Work History

Certified Trainer

Omnicare365
08.2024 - Current
  • Developed and delivered comprehensive training programs for new hires, ensuring a smooth onboarding process
  • Evaluated trainee performance through assessments and provided constructive feedback to facilitate skill development
  • Collaborated with management to identify key performance indicators (KPIs) for evaluating the impact of training initiatives
  • Delivered specialized technical trainings related to software applications or equipment operation
  • Provided ongoing support to employees after initial training by answering questions or providing additional resources as needed
  • Coached employees one-on-one to address specific skill gaps or performance issues identified during the training process
  • Collaborated with subject matter experts to stay updated on industry trends and incorporate relevant information into training content

Quality Assurance Analyst

UHC
10.2022 - Current
  • Chat Support Specialist- Assisting with multi chats (5 +) responses from advocates needing assistance with handling members accounts
  • Providing consultation and direction to ensure programs and services are implemented at the highest standards and patients receive the highest level of care
  • Ensures policies and procedures are monitored and updated to include regulatory changes
  • Acting as the liaison and primary resource to internal UHG clients and internal OptumRx departments for all client related matters including plan review, research, and effectively communicating to members and clients
  • Auditing calls for over 2,000 Healthcare Advocate that are assisting members with their health insurance policies
  • Direct contact with clients and managing client services
  • Understanding of data systems and analysis
  • Serve as the primary contact for escalated calls/e-mails from the client and assist with responding to service/operational issues providing prompt resolution for complete client satisfaction
  • Cultivate customer trust by providing day-to-day information regarding Benefit plans (co-payments, deductibles, quantity and days supply limitations, etc.) to assure accurate Claims processing and client/member satisfaction
  • Facilitate Client meetings and conference calls
  • Interface with Internal OptumRx resources (Customer Service, Implementation, Mail Service, Specialty, Clinical, Pharmacy Operations, Benefit Design, Eligibility or Client Management, Finance, etc) for further investigation and resolution of client needs or requests
  • Establish operational requirements and support daily client needs
  • Maintain critical client documentation including CID, IFS, plan matrixes, formulary database, rebate tracking tools, meeting agendas, notes, and action logs
  • Maintain expert knowledge of multi-channel processes, to include Plan Benefit information, Customer Service skills, phone and computer databases, and online support
  • Coordinate Eligibility process flow and troubleshoot problems
  • Ensures distribution of Medispan reports
  • Manage supplemental projects and processes involved with servicing clients
  • Requests and maintains client access to OptumRx systems (RxClaim, IDA, OLR, PAS, etc)
  • Train clients on Internal systems and procedures
  • Responsible for submitting and coordinating ongoing plan design changes
  • Responsible for working with Project Manager on New Client implementations
  • Support reporting needs of clients
  • Other duties as assigned

Quality Assurance Analyst

Wipro
Austin, TX
10.2021 - 07.2023
  • Primarily responsible for performing Quality transaction monitoring across the SBG Programs for internal stakeholders as well as external vendors in the region
  • Responsible for producing a high-level of market and quality insights, in collaboration with the respective CX Manager internally and externally to drive continuous improvement
  • Perform audits on recorded and live client interactions and provide evaluation feedback to call center agents through QMS
  • Conduct regular 1:1 or group calibration to ensure evaluations are aligned based on business requirements
  • Support the business in managing and implementing Quality Management standards and processes that are aligned with the global standard and relevant to the local market nuances
  • Highlight trends and red flags to the business for better improvements
  • Ensure accurate maintenance of sample calls/chats library in accordance with local legal requirements (i.e GDPR in EMEA)
  • Collaborate with internal and external stakeholders, highlighting QA trends and insights to the business
  • Provide a bi-weekly QA dashboard highlighting QA audits completion and QA trends to all stakeholders

Humana QA Analyst

Teleperformace Call Center
Killeen, TX
12.2018 - 06.2019
  • Monitor and evaluate inbound and outbound interaction quality
  • Tracking issues in the quality monitoring systems or tools and analyzing the results
  • Meeting monitors goals each day
  • Providing feedback to improve performance and develop training programs
  • Work with other internal teams to define quality metrics
  • Typically requires a bachelor's degree
  • Typically reports to a manager
  • Gaining exposure to some of the complex tasks within the job function
  • Occasionally directed in several aspects of the work

Escalation Account Supervisor

Teleperformance/Humana
Killeen, TX
02.2018 - 12.2018
  • Taking Escalation Calls from Agents that were not able to de-escalate their call and now the member/caller is requesting to speak with a supervisor
  • Read and understand insurance benefits to estimate coverage and patient out of pocket responsibility
  • Customer service (internal/external)
  • Making Outbound calls to Doctors/Specialist Offices along with Pharmacies to resolve billing issues for denied claims
  • Documenting case files with complete notes on work
  • Complete special projects with varied and complex components as needed
  • Maintain department quality and efficiency standards
  • Demonstrated experience in providing customer service in a large office environment
  • Healthcare experience; Prior insurance benefit or claims knowledge; Prior knowledge of patient assistance programs; Medical and Pharmacy benefit knowledge; Microsoft Access; Pharmacy Claims; Verification of Benefits; Billing Management for members Premiums

Healthcare Customer Care Representative

Teleperformance
Killeen, TX
07.2017 - 02.2018
  • Accepting payments from members for their monthly plan premium (Credit Card Visa, Master, Discover; ACH payment from Bank)
  • Setting up recurring payments from member's Credit Card, Bank, or selecting Social Security as their payment method
  • Educating member on when premium payments are due for their plan and given timeframe on when payments will post to account

Pharmacy Claims Specialist

Teleperformance
Killeen, TX
07.2017 - 02.2018
  • Handling inbound calls regarding RX medication and/or claims
  • Reworking submissions in addition to working with pharmacy claims data
  • Completing Mail Order Overrides for members that receive Humana Pharmacy mail order and have not yet received their medication on time and are completely out of their medication
  • Completing Overrides for members that receive Dosage change for medication and/or Authorization put in by PCP (Primary Care Provider)
  • Knowledge of pharmacy claims processing and systems
  • Using technology that includes Microsoft Excel, Microsoft Access, RX Nova, EDW, and PL/SQL developer
  • Requires interpretation and independent determination of appropriate courses of action for each submission
  • Resolving Coordination of benefits with the member's account so that RX Claims can process successfully
  • Ensure timely and effective communication with other departments who use or obtain results from Rework
  • Maintain department, CMS, and Compliance timelines
  • Document and maintain process flows and work instructions

Benefit Specialist

Teleperformance
Killeen, TX
07.2017 - 02.2018
  • Educating member on the type of policy they have that would require a Referral to see a Specialist; cost of services, monthly premium amount, copayments for services and Pharmacy copayments
  • Completing PCP changes for member based on state regulations
  • Providing In Network and Out of Network benefits for procedures and or test the member may receive with a facility
  • Giving In-Network information to member for Pharmacies, Facilities, Specialist, and Primary Care Providers
  • Educating member if the procedure they will be having will require an Authorization in order for Humana to pay for the cost of service
  • Enter individual eligibility information into carrier portal, including new enrollments, changes & terminations
  • Find assigned groups for processing using the manual changes database
  • Resolve issues by working with the ticketing system
  • Ensure positive customer experiences, both externally & internally
  • Litton Access- (CMS, Medicare, Medicaid Database)

Financial Aid Adviser

Blackboard
Killeen, TX
08.2015 - 10.2015
  • Uses discretion and independent judgment to advise and counsel students, parents, and/or prospective students in solving their educational financial problems through scholarships, loans, grants, employment and financial counseling
  • Live Chats with all students in regards to financial and academic regulations questions
  • Assisting college university staff with human resources application process and help desk log in issues
  • Respond to questions and counseling needs by phone from currently enrolled students, prospective students and parents
  • Assists outreach staff with prospective students and in their transition to current students
  • Performs reviews for professional judgment of student files, reviews Satisfactory Academic Progress appeal inputs and review decision makings to student
  • Serves as regularly scheduled Quick Queue agent greeting visitors, answering inquiries regarding federal financial aid forms, records, procedures, and policies
  • Learns to award, revise and/or approve the awarding of financial aid through the specific controls of program policy and guidelines
  • Assists with review, revision, and interpretation of complex rules, regulations, procedures and policies relating to general financial aid, scholarships, and team specialty area(s)
  • Learns to interpret and maintain knowledge of current federal, state and institutional policies, procedures and regulations pertaining to financial aid, student employment and scholarships

Education

Certification in Medical Administration -

Gary Job Corps
San Marcos, TX
01.2015

High School Diploma -

Shoemaker High School
Killeen, TX
01.2009

Skills

  • Benefits Specialist
  • Billing
  • Training needs analysis
  • Soft skills training
  • Technical Support
  • Pharmacy Claims
  • Medical claims
  • Medical Terminology
  • Call Center
  • Customer service
  • Outlook
  • Data Entry
  • Customer service support
  • Basic Microsoft
  • 48 WPM
  • Live chat support
  • Windows
  • Communication skills
  • Sales
  • Time management
  • User Interface (UI)
  • Documentation review
  • Databases
  • HEDIS
  • Medicare & Medicaid
  • DME
  • Medical billing & coding
  • ICD-10
  • Payroll management
  • CPT coding

Certification

  • Certified Medical Administrative Assistant, March 2015 - March 2017

Languages

English, Fluent

Assessments

  • Customer focus & orientation, Proficient, 09/01/21
  • Administrative assistant/receptionist, Proficient, 08/01/22
  • Attention to detail, Proficient, 08/01/22
  • Call center customer service, Proficient, 09/01/22
  • Technical support: Customer situations, Proficient, 09/01/22
  • Scheduling, Proficient, 08/01/22

Languages

English
Professional

Accomplishments

  • Perfect Attendance Recognition, 2022-2024
  • 2024 Award for Top Performance
  • Key Performance Indicator (KPI) & Survey Goal Keeper Certification, 2022-2023

Timeline

Certified Trainer

Omnicare365
08.2024 - Current

Quality Assurance Analyst

UHC
10.2022 - Current

Quality Assurance Analyst

Wipro
10.2021 - 07.2023

Humana QA Analyst

Teleperformace Call Center
12.2018 - 06.2019

Escalation Account Supervisor

Teleperformance/Humana
02.2018 - 12.2018

Healthcare Customer Care Representative

Teleperformance
07.2017 - 02.2018

Pharmacy Claims Specialist

Teleperformance
07.2017 - 02.2018

Benefit Specialist

Teleperformance
07.2017 - 02.2018

Financial Aid Adviser

Blackboard
08.2015 - 10.2015

Certification in Medical Administration -

Gary Job Corps

High School Diploma -

Shoemaker High School

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Tiarra Butler