Toia D. Kelley
Jacksonville,FL
Summary
Seasoned professional with extensive experience in the insurance industry, showcasing a proven track record in customer relations. Adept at navigating complex insurance processes while providing excellent customer service.
Overview
25
25
years of professional experience
Work History
Insurance Processing Expert (Contractor)
BCforward Staffing
05.2023 - Current
- Oversee Intake Site and Report Monitoring, ensuring accuracy
- Give invaluable guidance and mentorship to new process experts
- Investigate operational workflow issues and system irregularities to enhance overall efficiency
- Actively participate in developing and testing process enhancements for new system accounts
- Assist in crafting and executing project plans, ensuring effective communication of project status
- Provide comprehensive support and triage during the migration of the Life and Disability business to analyze and promptly resolve high-priority inquiries, prioritizing root cause determination
- Serve as a knowledgeable intermediary, facilitating communication between internal and external business.
Customer Care Advocate
United Healthcare
10.2022 - 05.2023
- Efficiently resolved customer service inquiries and concerns during initial calls, covering benefits, claims, eligibility, financial spending accounts, and correspondence
- Facilitated communication with care providers, including doctor's offices, to assist customers in appointment scheduling and connecting them with internal specialists
- Guided customers using myuhc.com and other UnitedHealth Group websites
- Assisted and educated customers on consumer-driven healthcare topics, enabling them to make informed decisions, optimize benefit plans, and select high-quality healthcare providers.
Customer Service Assistant 2 (Contractor)
State of Ohio, Office of Unemployment
08.2019 - 01.2022
- Provided phone support to claimants and employers of Ohio Unemployment Insurance during Covid
- Acted as a subject matter expert, managing the OUIO question board and aiding colleagues
- Observed and reviewed phone calls to identify coaching opportunities for new hires and peers
- Adjudicated Claims.
Complaint Analyst 1 (Contractor)
State of Ohio, Department of Insurance
09.2019 - 12.2019
- Assisted and provided information to consumers regarding insurance inquiries related to Medicare options, including Part D
- Formulated Medicare Advantage and Part D comparison reports using Medicare's Plan Finder tool
- Responded to questions regarding the Low-Income Subsidy (LIS) program and Medicare Advantage
- Enrolled callers in Medicare and filed out LIS application.
Logistics Coordinator
Savages Services
09.2019 - 12.2019
- Managed the transportation of goods for a third party, coordinating deliveries by rail car and tractor-trailer to end customers
- Oversaw customer inventory and collaborated with suppliers to negotiate terms
- Handled time-sensitive orders and processed modifications efficiently.
Sr. Appeals Rep
United Healthcare
01.2018 - 08.2019
- Verified member eligibility, Medicare plan options, and low-income subsidies while managing Medicare grievance cases with professionalism and compassion
- Ensured resolution of claims within the thirty-day timeframe specified by Medicare
- Initiated outbound communication with members or providers to verify critical data and clarify information.
Customer Service Supervisor
Alliance Data
11.1999 - 03.2012
- Coordinated and supervised all customer service representatives' daily, weekly, and monthly activities
- Ensured reliable quality service to all customers
- Served as the escalation point for Team Leads and SMEs on procedural and technical issues
- Provided feedback to the team and monitored performance against established business objectives
- Ensured adherence to standard policies and procedures.
Skills
- Content Writing
- Scheduling and Planning
- Logistics Coordination
- Contract Management
- Staff Management
- Customer Support
- Quality Assurance
- Microsoft Word
- Teamwork and Collaboration
- Public Speaking
- Research
- Multitasking Abilities
- Remote Office Availability
- Multitasking
Timeline
Insurance Processing Expert (Contractor)
BCforward Staffing
05.2023 - Current
Customer Care Advocate
United Healthcare
10.2022 - 05.2023
Complaint Analyst 1 (Contractor)
State of Ohio, Department of Insurance
09.2019 - 12.2019
Logistics Coordinator
Savages Services
09.2019 - 12.2019
Customer Service Assistant 2 (Contractor)
State of Ohio, Office of Unemployment
08.2019 - 01.2022
Sr. Appeals Rep
United Healthcare
01.2018 - 08.2019
Customer Service Supervisor
Alliance Data
11.1999 - 03.2012
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