Tomeka Hinton
Summary
Detailed-oriented and customer-focused professional with experience in handling inbound/outbound calls, verifying benefits, and resolving complex issues in a healthcare setting. Seeking to leverage effective communication skills and computer proficiency to excel in the role of Lead Customer Service Representative at United Healthcare
Overview
10
10
years of professional experience
Work History
SR. Clinical Administrative Coordinator
United Healthcare/Optum Services
06.2021 - Current
- Completes telephonic outreach to DSNP members utilizing auto dialer and manual dialing
- Assists members with social determinants of health and links to community resources
- Ensures members have access to PCP
- Identifies gaps in care and assists in closure of gaps
- Consistently meets metrics, both Quality and Performance
- Maintains confidential health information according to state and federal regulations including HIPAA.
Claims Adjustment Specialist
United Healthcare
12.2018 - 06.2021
- Primary responsibility is processing rework issues
- Communicate any changes in trending of inventory, volumes, and quality remediation
- Ability to manage escalations as needed
- Meet and maintain minimum quality and productivity standards
- Ability to manage most claim types / cases / issues that are submitted to the team I’m supporting.
Provider Resolution Specialist E&I
United Healthcare
11.2015 - 12.2018
- Answer 50-70 incoming provider calls, analyze and identify the provider’s service issue (i.e
- Benefit and eligibility, billing and payments, prior authorizations for treatment and explanation of benefits-EOBs)
- Deliver all information and questions in a positive, conversational, and compassionate manner to facilitate developing a relationship with the provider, while providing the best customer service experience possible
- Seek opportunities to reduce the administrative burden on the provider by advocating new tools or submission points.
Customer Service Representative
Industrial Staffing Services
06.2015 - 11.2015
- Resolve customer complaints via phone, email, mail
- Place outbound calls to reach out to customers and verify account information
- Assist with placement of orders for products, refunds, or exchanges.
Technical Customer Service Associate
Convergys
07.2014 - 04.2015
- Answers incoming customer calls regarding technical issues, product problems, service questions and general client concerns
- Update customer information in the customer service database during and after each call
- Provides timely feedback to the company regarding service failures or customer concerns.
Education
Dental Assistant -
Missouri College
Brentwood, MO05.2010
Medical Office Computers -
Midwest Institute for Medical Assisting
Earth City, MO04.2003
Child Development -
South Technical High school
Sunset Hills, MO06.1995
Skills
- Proficient in computer navigation and Windows PC applications, adept at learning new and complex systems quickly
- Excellent verbal and written communication skills, with the ability to engage effectively with customers and colleagues
- Strong problem-solving abilities, capable of resolving issues in fast-paced and dynamic environments
- Detailed-oriented with a focus on accuracy in documenting and resolving customer inquiries
- Ability to manage time effectively and prioritize tasks to meet deadlines and exceed customer expectations
- Familiarity with healthcare terminology and process, enhancing ability to assist callers with medical-related inquiries
- Commitment to maintaining information privacy and security in the telecommuting environment
- Demonstrated ability to manage conflicts and stressful situations with a dedicated home office setup ensuring privacy and security of company-sensitive information
- Access to dependable high-speed internet connection meeting company standards for telecommuting
Timeline
SR. Clinical Administrative Coordinator
United Healthcare/Optum Services
06.2021 - Current
Claims Adjustment Specialist
United Healthcare
12.2018 - 06.2021
Provider Resolution Specialist E&I
United Healthcare
11.2015 - 12.2018
Customer Service Representative
Industrial Staffing Services
06.2015 - 11.2015
Technical Customer Service Associate
Convergys
07.2014 - 04.2015
Dental Assistant -
Missouri College
Medical Office Computers -
Midwest Institute for Medical Assisting
Child Development -
South Technical High school
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