Summary
Overview
Work History
Education
Skills
Timeline
CustomerServiceRepresentative

Tinasha Sims

Columbia,MS

Summary

Customer Service Specialist with Tier 2 expertise in healthcare and insurance support, skilled in resolving escalated cases, ensuring compliance with HIPAA and CMS regulations, and delivering exceptional member experiences. Proven track record in claims processing, eligibility verification, and benefits education, as well as cross-industry experience in tax support, virtual education, and retail. Adept at managing high-volume environments and achieving top performance metrics.

Overview

6
6
years of professional experience

Work History

Customer Service Representative

Concentrix
01.2024 - 02.2025
  • Provided Tier 1 and Tier 2 support for tax preparation software users, assisting with account setup, billing issues, and troubleshooting software errors.
  • Educated customers on tax filing requirements and IRS compliance policies, improving user accuracy and reducing errors.
  • Resolved an average of 50+ inquiries daily with a 95% satisfaction rate, meeting strict quality assurance metrics. Guided families through K–12 virtual school enrollment, ensuring accurate documentation and compliance with state regulations.
  • Managed multiple platforms (CRM, SIS) to process applications and troubleshoot technical issues for parents and students.
  • Increased enrollment conversion rate by 15% through personalized support and follow-ups.
  • Delivered high-volume retail and e-commerce support for outdoor products, handling orders, returns, and product inquiries.
  • Assisted customers with loyalty programs and financing options, resulting in a 10% increase in credit card applications.
  • Maintained top-tier performance in sales add-ons and customer satisfaction across multi-channel support (phone, email, chat).

Customer Service Representative

Capitol Bridge Health Services
06.2023 - 12.2023
  • Serve as primary contact for escalated Medicare and Marketplace inquiries, including benefits verification, billing disputes, and claims adjustments.
  • Investigate and resolve complex eligibility and coverage issues requiring in-depth knowledge of healthcare policies and procedures.
  • Coordinate with Tier 3 teams and clinical departments to expedite prior authorizations and urgent medical requests.
  • Educate members on plan benefits, enrollment processes, and compliance requirements to improve satisfaction and reduce call-backs.
  • Utilize CRM systems (Salesforce, Facets, Avaya) to document and track all interactions with 99% accuracy.

Customer Service Representative

Maximus Federal Services
10.2020 - 06.2023
  • 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.
  • Researched and identified solutions to technical problems.
  • Delivered Tier 2 advanced support for healthcare and insurance inquiries, including Medicare and Marketplace plans, ensuring compliance with HIPAA and CMS regulations.

Housekeeping and Laundry Attendant

Forrest General Hospital
09.2018 - 05.2020
  • Removed bed sheets and towels from rooms and pre-treated stains to maintain and restore linen condition.
  • Sanitized all kitchen surfaces, wiped down cabinets, and swept and mopped floors
  • Demonstrated flexibility with scheduling, often taking on additional shifts or extending hours when needed to ensure completion of tasks.
  • Contributed to a positive work environment through effective communication and teamwork among housekeeping staff.
  • Engaged in housekeeping tasks by replacing linens and cleaning and sanitizing patient rooms.
  • Increased patient engagement by providing emotional support, companionship, and encouragement during challenging times.
  • Promoted a safe and clean environment by maintaining strict adherence to infection control protocols and sanitation standards.

Education

Bachelors Of Health Administration

East Marion High School
Columbia, MS
09-2028

Skills

  • Patient Support & Advocacy

  • Escalation Management

  • Medical Terminology Knowledge

  • Insurance Verification & Eligibility

  • Claims Processing & Adjustments

  • Prior Authorizations & Referrals

  • Appeals & Grievance

  • Handling Problem Resolution & Conflict Management

  • Empathy & Communication

  • High-Volume Call Handling

Timeline

Customer Service Representative

Concentrix
01.2024 - 02.2025

Customer Service Representative

Capitol Bridge Health Services
06.2023 - 12.2023

Customer Service Representative

Maximus Federal Services
10.2020 - 06.2023

Housekeeping and Laundry Attendant

Forrest General Hospital
09.2018 - 05.2020

Bachelors Of Health Administration

East Marion High School

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Tinasha Sims