Tonisha DeBose
Cleveland,OH
Summary
Experienced with customer support, delivering solutions and positive experiences. Utilizes strong communication and problem-solving skills to address and resolve member concerns. Track record of fostering member loyalty and maintaining high satisfaction levels.
Overview
6
6
years of professional experience
1
1
Certification
Work History
Member Care Specialist
Florida Blue
06.2023 - 01.2024
- Company Overview: Blue Cross and Blue Shield of Florida
- Taking incoming calls with inquiries for potential, new, and existing customers
- Review member's enrollment or claims history ensuring accuracy of billing and enrollment and application of deductible and member responsibility
- Utilize the Florida Blue Conversation Strategy to provide outstanding customer service and call resolution to our members
- Research and resolve service-related inquiries meeting established expectations for quality, productivity, and timeliness
- Provide exceptional customer service
- Collect, analyze and interpret complex policies, procedures and information from customers or 3rd parties
- Communicate effectively in person, via phone, and in writing
- Excel at meeting processing timeframes and managing an individual workload while working within a team
- Prepare and present documents verbally and in writing
- Demonstrate excellent organizational skills and strong attention to details
- Possess strong computer navigation and math skills
- Assisting members using probing questions and critical thinking to resolve their inquiry
- Thoroughly review and understand Explanation of Benefits (EOBs)
- Utilize payer websites & dedicated call centers for claim status and claim review
- Review and follow up on claim denials timely and take appropriate actions to resolve accounts
- Research claim facts for accuracy and request corrected claims as needed
- Provide feedback on payer trends and issues prohibiting payment to Lead/Manager and report issues and concerns regarding account resolution to avoid write offs
- Update demographic and insurance information in the billing system
- Note changes in account status on an ongoing basis in a clear and concise manner
- Properly note activities detailing the steps taken to resolve outstanding balance
- Blue Cross and Blue Shield of Florida
Customer Service
City of Cleveland
11.2019 - 11.2022
- Company Overview: Water Department
- Apply District policies and procedures relating to water and sewer service
- Read and transcribe numbers accurately
- Make accurate arithmetic calculations
- Handle cash, make change, and balance accounts
- Maintain attention to detail in a work situation with frequent interruptions
- Post and verify data accurately and quickly
- Prepare and maintain a variety of financial and statistical records
- Communicate tactfully and effectively with the public
- Understand and carry out oral and written instructions
- Operate business office equipment including computers and calculators
- Establish and maintain professional and effective working relationships with those contacted in the course of the work and provide excellent customer service
- Conduct work in a manner that supports the overall team effort, and which avoids disruption of one's work and the work of others
- Work cooperatively and communicate effectively with staff and the general public
- Proficient operation of government computer systems
- Inputs, verifies and processes customer data and billing information into the computer
- Maintains customer water and or sewer accounts
- Obtains required information from customers to begin and discontinue water and/or sewer service
- Accepts and accurately processes customer payments in person and over the phone
- Prepares accounts receivable billing and documentation
- Responds to customer billing inquiries or complaints, requiring the use of judgement and knowledge of District Rules, Regulations and approved policies and procedures
- Interacts with the public, on the telephone, via email and in person, in a satisfactory manner
- Calls and/or mails correspondence to customers as necessary in order to update customer accounts
- Prepares and processes customer notification of delinquent accounts
- Communicates with District field personnel via radio and/or telephone to relay customer service requests
- Answers telemetry alarms and distributes to appropriate personnel
- Performs a variety of clerical duties such as typing and filing
- Has regular attendance and adheres to prescribed work schedule to conduct job responsibilities
- Water Department
Insurance Agent
Homesite Insurance
04.2018 - 11.2019
- Evaluate clients' property and casualty insurance needs through detailed discussions, assessing risks and coverage requirements
- Design and customize insurance policies to suit individual client needs, including setting up appropriate coverage limits and deductibles
- Responsible for processing changes to existing policies in a timely and accurate manner
- Serve as a customer advocate for insurance clients while adhering to underwriting standards
- Strong Knowledge of Computer systems such as Centrix, Oracle, Epic, Customer Connect
- Able to adjust style and approach to suit situations that involve rapidly changing tasks, shifting priorities, and simultaneous demands
- Ability to communicate clearly and professionally both verbally and in writing, including effective use of listening skills
- Skilled in working independently, prioritizing, and following through on assignments with minimal direction
- Have a strong sense of urgency and willing to take extra measures when solving problems and getting work done
- Ability to make timely and sound decisions and solve problems by assessing relevant information
- Ability to notice discrepancies and inconsistencies in available information
- Models a high standard of quality and commitment to serving the public, including building strong relationships with members inside and outside the organization
- Capable of mentoring, motivating and guiding others toward both individual and organization goals
Education
Bachelor of Science - Sociology
Southern New Hampshire University
New Hampshire04-2026
Skills
- Call center experience
- Sales strategy
- Member correspondence
- Member account management
- Data security techniques
- Point of sale system
- CRM Software
- SalesForce
Accomplishments
- Collaborated with team in the development of chat box for florida blue AI sunny and Olive
Certification
- Certified Customer Experience Professional (CCEP) Customer Service Institute of America.
- Google Analytics Individual Qualification (IQ) – Google.
- Salesforce Certified Administrator - Salesforce.
- LiveChat Expert LiveChat, Inc.
- Certified Customer Service Professional (CCSP) - National Customer Service Association.
Timeline
Member Care Specialist
Florida Blue
06.2023 - 01.2024
Customer Service
City of Cleveland
11.2019 - 11.2022
Insurance Agent
Homesite Insurance
04.2018 - 11.2019
Bachelor of Science - Sociology
Southern New Hampshire University
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