Veronica L. Henry
Nashville,TN
Summary
Customer Service Advocate IV, with a background in providing exceptional support and resolving customer inquiries. Skilled in communication, problem-solving, and maintaining positive relationships within all departments. Committed to enhancing team performance by sharing knowledge and best practices in customer service operations, demonstrated ability to improve customer satisfaction and loyalty through attentive service and effective issue resolution.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Customer Advocate IV
Centene Corporation
Nashville, TN
03.2022 - Current
- Serve as a liaison between Customer Service Representatives (CSRs), management and other various departments. Provide support to several teams by resolving customer inquiries via telephone and written correspondence in a timely and appropriate manner.
- Investigate and resolve complex claims matters in coordination with health plan and/or corporate departments. Coordinate the day-to-day work functions, acting as a “go to” person and investigating and resolving complex issues. Initiate change requests to resolve system configuration questions impacting claims processing; review and test results.
- Conduct appropriate auditing processes.
- Reference current materials to answer escalated and complex inquiries from members and providers regarding claims, eligibility, covered benefits and authorization status matters.
- Educate members and/or providers on health plan initiatives; train and assist providers regarding proper claims billing procedures.
- Provide first call resolution and “own the process” by working with appropriate internal/external resources and ensure the closure of all inquiries.
- Document all activities for quality and metrics reporting through the Customer Relationship Management (CRM) application.
- Identify trends related to member and/or provider inquiries to respond proactively and provide feedback to management.
- Collaborate with other departments on cross functional tasks and projects Maintain performance and quality standards based on established call center metrics including turn-around times.
Customer Service Representative III
Centene Corporation
Nashville, TN
11.2018 - 03.2022
- Respond to member, provider, pharmacy and other inquiries via telephone, correspondence or lobby walk-in while meeting all corporate guidelines and performance standards.
- Demonstrate appropriate customer-care skills such as empathy, active listening, courtesy, politeness, helpfulness, and other skills as identified.
- Records, investigates, and resolves member complaints as detailed in the grievance procedure narrative.
- Assist in the education of new members and in the re-education of existing members regarding health plan procedures.
- Logs, tracks, and appropriately document all issues utilizing on-line systems and procedures, and in accordance with all applicable guidelines and requirements.
- As a Customer Service Rep III, I mentor and coach new and less experienced associates. Maintains department desk level procedures and tracks compliance to contractual standards. In process to learn how to perform quality assurance audits for telephone inquiry functions. Drafts/develops scripting based on Supervisor and Management input. Supports management reporting of daily operational statistics. Backs-up unit supervisors for specified functions and in supervisor’s absence, as determined by management and promotes teamwork.
Quality Assurance Auditor
WellCare Health Plans
Nashville, TN
10.2013 - 11.2018
- Perform compliance quality audits on all Inbound and Outbound call center teams. Including teams with casework in operations. Identify training opportunities, individual and team coaching needs and report findings to senior management.
- Develop and present ideas for performance and process improvement within the department.
- Assist in the development of QA strategies on policies, procedures, and systems to accurately measure and report areas of improvement. Manage turn-around times to ensure compliance with business requirements.
- Attend, and host calibration with site leaders.
Customer Service Representative
WellCare Health Plans
Nashville, TN
07.2012 - 10.2013
- Respond to member, provider, pharmacy and other inquiries via telephone, correspondence or lobby walk-in while meeting all corporate guidelines and performance standards.
- Demonstrate appropriate customer-care skills such as empathy, active listening, courtesy, politeness, helpfulness, and other skills as identified.
- Records, investigates, and resolves member complaints as detailed in the grievance procedure narrative.
- Assist in the education of new members and in the re-education of existing members regarding health plan procedures.
- Logs, tracks, and appropriately document all issues utilizing on-line systems and procedures, and in accordance with all applicable guidelines and requirements.
Education
2-year College Education -
Tennessee State University
Nashville, TNDiploma -
Whites Creek Comprehensive High School
Whites Creek, TNSkills
- Claims processing and auditing
- Quality assurance and CRM
- Health plan education
- Customer relationship management
Certification
- Healthcare Compliance Certified, Centene Health Plans, Inc., 2024
- Information Security Advocate Certified, Centene Health Plans, Inc., 2024
Timeline
Customer Advocate IV
Centene Corporation
03.2022 - Current
Customer Service Representative III
Centene Corporation
11.2018 - 03.2022
Quality Assurance Auditor
WellCare Health Plans
10.2013 - 11.2018
Customer Service Representative
WellCare Health Plans
07.2012 - 10.2013
2-year College Education -
Tennessee State University
Diploma -
Whites Creek Comprehensive High School