Tumu Newell

Assists customers with inquiries and resolves issues promptly. Utilizes CRM software to customer interactions and ensure follow-up. Delivers accurate information on health plan options and benefits. Collaborates with team members to enhance service delivery processes. Performs provider searches that match the member’s preferences. Assists members and clinical teams with provider searches and outreach, ensuring that the provider participates with the member's health plan. Coordinates and assists with preparing the member for upcoming doctor, specialist, and procedure visits. Provides and confirms benefits and eligibility, and provides members with directions or website navigation assistance. Faxes and mails information pertaining to post-care Explanation of Benefts, Explanation of Payments, Member ID cards and other follow-ups. Utilizes internal resources and education material to learn new policies and procedures, ensuring HIPAA compliance. Provides training support for new hires on customer service protocols and role subject matter.

Provided accurate information on insurance products to enhance customer understanding. Utilized CRM software to accurately document client interactions and track progress on outstanding issues. Worked in tandem with sales teams to identify cross-selling opportunities, growing the company''s book of business. Participated in ongoing training sessions to stay up-to-date on industry trends, product offerings, and regulatory changes. Assisted customers with completing insurance documents to avoid missed information. Responded to telephone, digital, and email customer-and-prospective-customer requests for products, services, and company information. Updated records to reflect current information. Fielded customer complaints, escalating complex issues to distinct leadership and corporate teams for resolution. Processed insurance policy cancellations and renewals. Maintained strong knowledge of basic medical terminology to better understand services and procedures. Made contact with insurance carriers to discuss policies and individual patient benefits. Processed policy renewals and endorsements efficiently to ensure uninterrupted coverage. Maintained up-to-date knowledge of industry regulations and compliance standards. Collaborated effectively with internal departments like claims adjusters, underwriting staff, allowing seamless coordination between parties involved in the client relationship management process.

Assisted member with making decisions about their healthcare needs by translating member's benefit packages and care plans. Conducted provider searches and addressed members' care need barriers. Identified appropriateness of care and connected member with the right clinical resource (ex. Clinician, Disease Management, Case Management, and Maternity. Assisted with coverage, plan information, member ID card requests, and account and insurance updates. Educated patients on available community resources such as copay assistance and medical appointment transportation. Assisted members and providers with precertification initiation and status requests.

Provided primary service contact with registered representatives. Conducted research and work with appropriate resources to obtain time-sensitive information for callers. Consulted with appropriate resources to identify action required in accordance with corporate compliance and regulatory requirements. Provided professional, accurate, prompt service to registered representatives and their clients, while offering respect, courtesy, and a sense of urgency at all times. Established rapport in servicing agencies requiring increasing sensitivity to meet their complex needs and/or high volumes. Processed disbursements and transfers and offered callers appropriate guidance with IRS rules, transactions, tax forms, and timelines.

Managed policy inquiries and provided accurate information to clients regarding coverage options. Processed policy changes, updates, and renewals. Resolved customer complaints through effective communication and problem-solving techniques. Handled customer inquiries regarding policy coverage and claims processing. Assisted policyholders in understanding policy options, enhancing customer satisfaction and retention. Ensured regulatory compliance by staying updated on industry standards and changes in state laws pertaining to insurance practices. Collaborated with sales team to identify opportunities for cross-selling or up-selling insurance products. Increased policyholder retention with exceptional customer service and detailed explanation of insurance coverages. Expedited claims resolution by liaising between clients, adjusters, and legal teams. Set up customer payments to cover annual policies and renewals.