Twila Weaver
Choctaw,OK
Summary
A detail‑oriented Quality and Research professional with extensive experience investigating a wide range of UHC insurance inquiries, analyzing complex issues, and identifying trends that enhance operational accuracy and member experience. Demonstrates strong capability in coaching, cross‑functional collaboration, and process optimization, consistently transforming insights into actionable recommendations. Recognized for advancing quality initiatives, ensuring consistency in service delivery, and supporting data‑driven decision‑making across the organization.
Overview
8
8
years of professional experience
Work History
SafeRide QOC Investigations
UnitedHealthcare
WFH
05.2025 - Current
- Investigate SafeRide transportation grievances by analyzing trip data, advocate calls and notes, and Maestro Member Account documentation to determine fault, leveraging Copilot to streamline review and identify recurring patterns.
- Maintain case records in the Government Ops Appeals & Grievance SharePoint to track trends, support compliance, and ensure accurate reporting.
- Communicate concise findings to clinical nurses and escalate advocate‑related errors to leadership with clear corrective‑action recommendations.
- Lead transportation QOC research, ensuring accuracy, consistency, and timely resolution while independently managing a full caseload.
- Demonstrate strong initiative and leadership by helping establish the URide QOC Research program, developing SOPs, training team members, and restoring program compliance while streamlining operations from a five‑researcher model to a single primary researcher with one designated backup.
- Collaborate on leadership presentations by preparing slide content, reflecting strong attention to detail, teamwork, and dependability.
Customer Service Team Lead-Government Operations
UnitedHealthcare
WFH
07.2022 - 05.2025
- Mentored and coached Customer Service Advocates by delivering performance feedback from call evaluations and closed loops, improving compliance, service quality, and NPS/UES outcomes.
- Led training on customer service best practices, grievance and appeal policies, and system workflows, and built step‑by‑step training documentation using Scribe to support consistent learning and team development.
- Managed queues, schedules, and team adherence through Pulse and Supervisor Webstation to maintain optimal coverage and meet service‑level targets.
- Supported representatives during complex customer interactions, providing guidance on effective communication and de‑escalation strategies.
- Cultivated a positive team culture through engagement initiatives and implemented process improvements to enhance efficiency and service delivery.
Trainer-Customer Service Onboarding & Development
UnitedHealthcare
WFH
03.2022 - 12.2022
- Delivered comprehensive onboarding and on‑the‑job training for new Customer Service Advocates, applying varied instructional methods to support diverse learning styles and ensure readiness for live call environments.
- Facilitated call‑shadowing sessions and provided real‑time guidance through team chats, helping new hires navigate tools including Maestro, Knowledge Central, Rally, and MARX.
- Assessed performance using Qualtrics, Qfiniti, and Nexidia, providing targeted coaching and actionable feedback to close skill gaps and elevate service quality.
- Documented attendance, behavioral observations, and coaching results, and communicated these insights to Partner Support Staff using PMC and adherence‑tracking systems.
Customer Service Advocate-Government Operations
UnitedHealthcare
WFH
06.2021 - 06.2022
- Resolved member inquiries regarding benefits, eligibility, claims, and plan changes, consistently achieving first‑call resolution and delivering exceptional service.
- Educated members on medical, drug, dental, vision, and wellness benefits, and supported them with provider scheduling and pharmacy coordination.
- Identified urgent member needs and connected individuals to appropriate community and support resources.
- Managed and updated member information using Maestro, GPS, ICUE, Employer Group Grif, IBAQ, and Knowledge Central, while facilitating effective cross‑team collaboration.
Member Retention Concierge Advocate
UnitedHealthcare
WFH
10.2021 - 02.2022
- Handled inbound calls regarding enrollment, plan changes, and reinstatements, resolving issues promptly to support member retention.
- Educated members on plan benefits and guided them through plan comparisons to ensure they selected coverage that best aligned with their needs.
- Applied active listening and analytical problem‑solving to address concerns, enhance member satisfaction, and reduce disenrollment risks.
Subject Matter Expert-CalPERS
OptumRX
WFH
08.2020 - 05.2021
- Served as the SME for the CalPERS team, guiding representatives with expert resources to resolve complex member and pharmacy issues across multiple lines of business.
- Mentored team members through real‑time chat support, sharing tools, SharePoint resources, and job aids to improve accuracy and efficiency.
- Investigated and resolved escalated cases, providing member and pharmacy callbacks to ensure issue resolution and prevent repeat escalations.
- Leveraged RxClaims to manage holding plans, complete overrides, and execute temporary account updates.
Customer Service Advocate
OptumRX
WFH
04.2018 - 07.2020
- Delivered comprehensive support to members, physician offices, and internal teams by resolving inquiries related to benefits, claims, billing, Medicare Part D, and OptumRx mail services.
- Served as a primary liaison for retail pharmacies, resolving claim rejections, medication coverage issues, and member processing concerns.
- Leveraged RxClaims to complete account updates, process overrides, and ensure accurate and timely resolution of member issues.
- Supported high‑touch clients and specialized lines of business, strengthening service levels and contributing to operational efficiency.
Education
Graduate Certificate - Social Service Director
Oklahoma State Department of Health
Tulsa, OKGraduate Certificate - Business Management and Accounting
Caddo-Kiowa Vo-Tech
Ft. Cobb, OKSkills
- Copilot
- Scribe
- Genesys - Pulse - GPS - ICUE - Knowledge Central
- MARX
- Microsoft Excel - Word - PowerPoint
- MyMetric
- Nexidia - Qfiniti
- PMC - Qualtrics - Supervisor Webstation
- RxClaims
- SafeRide
- SharePoint
- Government Operations Workforce Management
Timeline
SafeRide QOC Investigations
UnitedHealthcare
05.2025 - Current
Customer Service Team Lead-Government Operations
UnitedHealthcare
07.2022 - 05.2025
Trainer-Customer Service Onboarding & Development
UnitedHealthcare
03.2022 - 12.2022
Member Retention Concierge Advocate
UnitedHealthcare
10.2021 - 02.2022
Customer Service Advocate-Government Operations
UnitedHealthcare
06.2021 - 06.2022
Subject Matter Expert-CalPERS
OptumRX
08.2020 - 05.2021
Customer Service Advocate
OptumRX
04.2018 - 07.2020
Graduate Certificate - Social Service Director
Oklahoma State Department of Health
Graduate Certificate - Business Management and Accounting
Caddo-Kiowa Vo-Tech