VENESSA HINES
Menands,New York
Summary
Experienced manager and customer service administrator with over 10 years of expertise in retail and health insurance sectors. Thrives in fast-paced, collaborative settings and possesses extensive knowledge of NYS health insurance programs, including marketplace eligibility and enrollment policies, procedures, benefits, and covered services across all state and federal programs (Medicaid, Medicare, Child Health Plus, Essential Plan, etc.). Demonstrates a strong commitment to providing exceptional customer service and ensuring client satisfaction.
Overview
13
13
years of professional experience
Work History
Senior Operations Task Team Administrator
New York State of Health
2024.05 - Current
- Review and process incidents and defects submitted by the Call Center and Eligibility & Enrollment and determine appropriate resolution (120%+ production rate)
- Troubleshoot defects in consumer applications via Jira
- Review consumer requests for accuracy and make changes to records as necessary
- Identify issues proactively and escalate to management as appropriate
- Maintain up to date knowledge of all Call Center and Eligibility & Enrollment performance requirements as well as corporate and project policies and procedures
CSS IV Delegated Administrator
New York State of Health
2017.09 - 2023.05
- Completed manual overrides on Marketplace application for consumers who need a Health Exchange ID override
- Addressed customer's inquiries and resolve problems to ensure that appropriate changes are made to accounts
- Provided precise steps needed to register an NY.GOV ID and online navigation.
- Performed password resets and email updates via Delegated Administration
CSS III Policy Administrator
New York State of Health
2016.05 - 2017.09
- Implemented program policies & procedure to meet state and federal regulatory requirements.
- Processed applications to determine financial eligibility for enrollment in public health insurance plans and government funded health services programs.
- Met quality assurance and key performance metrics
- Analyzed 1095 tax documents
Customer Service Associate
Kohl's
2015.09 - 2016.05
- Investigated and resolved customer inquiries and complaints in a timely and empathetic manner
- Built long-term customer relationships and advise customers on purchases and promotions
- Helps drive sales goals and achieve monthly quotas
Assistant Manager
Family Dollar
2011.11 - 2016.05
- Managed a team of 10+ employees
- Performed weekly ordering of merchandise using cycle counts to ensure in-stock representations
- Completed profit and loss performance reports
- Unloaded all merchandise from delivery truck, organized and transferred stock from stockroom to store
Education
Bachelor of Science - Substance Abuse and Behavioral Counseling
Post University
Waterbury, CT01.2020
High School Diploma -
Shaker High School
Latham, NY01.2012
Skills
- Office Management
- Policy Enforcement
- Document Management
- Quality Assurance and Control
- Technological Problem Solving
- Software Implementation
- Information Optimization
- Critical Thinking
- Written/Oral Communication
- Attention to Detail
- Time Management
- Able to Multitask
- HIPAA Compliance
- Medical Records Management
Software
- Expert knowledge in the following software systems: eMedNY, ePaces, BackOffice, JIRA, Delegated Administration, MAXe, Siebel, Oracle Knowledge, Verint, Outlook Suite & Microsoft Office
Awards
- Quarterly Award Recipient, 11x quarterly award recipient. Recognized for consistently high performance and excellent work in the NYSOH contact center. Top 5% of high performers in the project.
- Awarded 2019 Most Valuable Player award with performance metrics at 95% or higher project wide (of 5,000+ employees).
Volunteer Experience
Crisis Counselor, Crisis Text Line, 05/01/19, Present, Skilled in successfully and empathetically navigating crisis intervention., Trained in active listening, collaborative problem solving and safety planning.
Languages
Jamaican Patois
Native or Bilingual
Spanish
Limited Working
Timeline
Senior Operations Task Team Administrator
New York State of Health
2024.05 - Current
CSS IV Delegated Administrator
New York State of Health
2017.09 - 2023.05
CSS III Policy Administrator
New York State of Health
2016.05 - 2017.09
Customer Service Associate
Kohl's
2015.09 - 2016.05
Assistant Manager
Family Dollar
2011.11 - 2016.05
Bachelor of Science - Substance Abuse and Behavioral Counseling
Post University
High School Diploma -
Shaker High School