Tiffany James
Riverview,FL
Summary
Dynamic Grievance Specialist at Elevance Health with a proven track record in effective conflict resolution and problem management. Enhanced customer satisfaction through strategic process improvements and clear communication. Skilled in multitasking and time management, consistently achieving high performance metrics while fostering collaboration across teams.
Results-driven professional prepared for roles demanding high standards and effective grievance handling. Proven ability to manage sensitive cases and ensure compliance with regulations. Known for fostering teamwork and delivering reliable solutions in dynamic environments. Proficient in conflict resolution and adaptable to evolving challenges.
Overview
13
13
years of professional experience
Work History
Grievance Specialist
Elevance Health
12.2021 - Current
- Analyzed grievances to identify trends and areas for process improvement.
- Collaborated with cross-functional teams to resolve complex member issues efficiently.
- Managed case documentation ensuring compliance with internal policies and regulations.
- Facilitated communication between members, providers, and departments to maintain service quality.
- Conducted root cause analysis on recurring grievances to drive strategic improvements.
- Implemented feedback loops to enhance member satisfaction based on grievance outcomes.
- Improved customer satisfaction by efficiently handling and resolving grievances.
- Managed 60 plus grievance cases for timely resolutions, enhancing company reputation.
- Consistently met performance metrics such as quality scores and case closure rates, demonstrating commitment to excellence in handling customer grievances.
- Effectively communicated case updates to clients, ensuring transparency throughout the resolution process.
- Submitted verbal and written notification to members and providers.
- Provided outreach for additional information for grievances.
Elevator Dispatcher
ThyssenKrupp Elevator
06.2018 - 04.2021
- Coordinated logistics and scheduling for elevator installation and maintenance services.
- Monitored service requests and prioritized dispatch to ensure timely responses.
- Utilized computerized dispatch systems to track technician locations and job statuses.
- Mentored new dispatch staff on operational procedures and customer service standards.
- Streamlined communication between technicians, customers, and management teams to improve service efficiency.
- Collaborated with cross-functional teams to enhance workflow processes and reduce response times.
- Managed high-stress situations calmly and effectively, ensuring timely assistance to those in need.
- Communicated with drivers and personnel to coordinate timely delivery of goods and materials.
- Collaborated with fellow dispatchers to maintain a seamless workflow during shift changes.
- Provided exceptional customer service to callers, remaining empathetic and patient during emergencies.
- Promoted teamwork among colleagues by proactively assisting others when needed.
- Trained new dispatchers on company protocols, contributing to a well-prepared team of professionals.
Customer Service Representative
CVS Specialty Pharmacy
06.2016 - 06.2017
- Provided exceptional support to patients by addressing inquiries and resolving issues efficiently.
- Coordinated medication refills and ensured timely delivery of specialty pharmaceuticals.
- Educated patients on proper medication usage and potential side effects to enhance compliance.
- Collaborated with healthcare providers to streamline prescription processes and improve patient outcomes.
- Trained new team members on best practices for customer service and pharmacy operations.
- Monitored inventory levels and coordinated with vendors to maintain adequate supply of medications.
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
- Responded to customer requests for products, services, and company information.
- Delivered prompt service to prioritize customer needs.
- Identified and resolved discrepancies and errors in customer accounts.
Call Center Supervisor
General Dynamics
08.2014 - 07.2016
- Led team of customer service representatives to enhance service quality and improve customer satisfaction.
- Implemented training programs to develop staff skills and promote professional growth within the team.
- Analyzed call center metrics to identify trends and optimize operational efficiency across multiple shifts.
- Developed and maintained standard operating procedures ensuring compliance with company policies and industry regulations.
- Monitored performance metrics, providing feedback to staff to foster a culture of continuous improvement.
- Conducted regular coaching sessions, enhancing team performance through targeted skill development initiatives.
- Trained team members on performance metrics and consumer behavior identification.
- Reduced average handle time through the implementation of effective call handling techniques and scripts.
- Increased first-call resolution rates by equipping agents with comprehensive knowledge of products and services.
- Maintained open lines of communication between management and staff, fostering a transparent workplace culture that encouraged collaboration and innovation.
- Promoted employee engagement by recognizing outstanding performance and rewarding top performers accordingly.
Medicare Customer Service Representative
General Dynamics
07.2012 - 07.2014
- Resolved complex Medicare inquiries, ensuring accurate information delivery and enhancing customer satisfaction.
- Educated members on benefits, eligibility, and enrollment processes, improving understanding and compliance.
- Streamlined call handling procedures, reducing average response time while maintaining service quality standards.
- Collaborated with healthcare providers to address patient concerns, facilitating timely resolution of issues.
- Mentored junior representatives on best practices for customer interactions and problem-solving techniques.
- Led training sessions for new hires, fostering a knowledgeable team focused on exceptional service outcomes.
- Enhanced customer satisfaction by efficiently addressing and resolving Medicare-related inquiries.
- Provided exceptional support to Medicare beneficiaries, guiding them through coverage options and plan details.
- Managed a high volume of inbound calls, adeptly navigating multiple systems while maintaining focus on customer needs.
- Improved call center performance by consistently maintaining a high level of professionalism and productivity.
- Reduced call handling time with efficient problem-solving skills and comprehensive knowledge of Medicare policies and procedures.
- Streamlined claim processing for quicker reimbursements, diligently reviewing submitted documentation.
- Established trust among customers by demonstrating empathy during challenging situations, providing reassurance, and offering expert guidance on available resources.
- Upheld strict confidentiality standards while managing sensitive beneficiary information during interactions and data entry tasks.
- Maintained up-to-date knowledge of product and service changes.
- Delivered exceptional customer service to every customer by leveraging extensive knowledge of products and services and creating welcoming, positive experiences.
- Educated customers about billing, payment processing and support policies and procedures.
Education
Associate of Science -
Hillsborough Community College
Tampa, FL08-2027
Required Courses
Wharton High School
Tampa, FL06-2009
Skills
- Experienced in problem management
- Mediation expertise
- Effective conflict resolution
- Clear and concise communication skills
- Effective prioritization and multitasking
- Time management expertise
- Strong computer skills with deadline management
Timeline
Grievance Specialist
Elevance Health
12.2021 - Current
Elevator Dispatcher
ThyssenKrupp Elevator
06.2018 - 04.2021
Customer Service Representative
CVS Specialty Pharmacy
06.2016 - 06.2017
Call Center Supervisor
General Dynamics
08.2014 - 07.2016
Medicare Customer Service Representative
General Dynamics
07.2012 - 07.2014
Associate of Science -
Hillsborough Community College
Required Courses
Wharton High School
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