Summary
Overview
Work History
Education
Skills
Timeline
Generic

YOLANDA HORNE

Miami,FL

Summary

Results-driven Representative known for productivity and efficiently completing tasks. Skilled in client communication, problem resolution, and process optimization. Excel in negotiation, strategy development, and customer relationship management. Leverage active listening, empathy, and persuasive speaking to achieve objectives and exceed goals.

Overview

25
25
years of professional experience

Work History

Customer Service Utilization Representative

United Healthcare Group
Miami, FL
12.2017 - Current
  • Provided customer service by answering product and service related questions.
  • Created displays for merchandise according to company guidelines and standards.
  • Conducted initial eligibility screenings for Medicaid applicants.
  • Reviewed applications and supporting documents to determine applicant's eligibility for Medicaid benefits.
  • Compiled and documented information regarding applicant's income, assets, insurance coverage and other relevant data.
  • Verified accuracy of applicant's financial information against third-party sources such as employers, banks or government agencies.
  • Assisted individuals with the completion of complex paperwork related to their application process.

Team Leader

Emblem Health Insurance
Hollywood, FL
08.2013 - 09.2016
  • Coordinated team activities and delegated tasks to ensure efficient completion of projects.
  • Created training materials and conducted group trainings on new processes or procedures.r
  • Assisted in the preparation of documents for claims processing.
  • Answered inquiries from customers regarding their individual claims status.
  • Investigated and resolved discrepancies in claims data entries.
  • Provided customer service support for employee inquiries related to benefits, including health insurance and retirement plans.
  • Maintained confidentiality of all patient information according to HIPAA regulations.
  • Resolved escalated customer disputes in a timely manner while maintaining good relationships with customers.
  • Identified needs of customers promptly and efficiently.
  • Provided excellent service and attention to customers when face-to-face or through phone conversations.

Anticapated Care Advocate

Emblem Health Insurance
Hollywood, FL
10.2011 - 08.2013
  • Assisted in coordinating services such as medical appointments and home visits.
  • Assisted with obtaining and managing authorization forms from healthcare providers.
  • Maintained accurate records of authorization requests and outcomes.
  • Provided support by answering inquiries related to the authorization process.
  • Followed up on pending authorizations as needed.
  • Analyzed trends in denied authorizations and provided recommendations for improvement.
  • Ensured all data entered into system is accurate and up-to-date.

Customer Service Representative

Emblem Health Insurance
Hollywood, FL
11.1999 - 10.2011
  • Answered customer inquiries and provided accurate information regarding products and services.
  • Managed incoming calls from patients and other healthcare facilities to provide information or schedule services.
  • Assisted in checking patient's insurance eligibility prior to their appointment.
  • Maintained client confidentiality according to HIPAA regulations at all times.
  • Answered phone calls and directed them to appropriate personnel.
  • Analyzed documentation submitted by customers to determine validity of claims.
  • Monitored customer accounts for any changes that may impact their coverage or premium costs.
  • Worked closely with supervisor and team members in order to ensure quality standards were met.

Education

High School Diploma -

Miami Northwestern Sr High School
Miami, FL
06-1988

Skills

  • Client services
  • Product promotions
  • Billing coordination
  • Appointment scheduling
  • Project management
  • Claims monitoring
  • Payment processing
  • Phone etiquette
  • Inbound customer service
  • Documentation and reporting
  • Customer relations
  • Problem resolution
  • Senior leadership support
  • Product knowledge

Timeline

Customer Service Utilization Representative

United Healthcare Group
12.2017 - Current

Team Leader

Emblem Health Insurance
08.2013 - 09.2016

Anticapated Care Advocate

Emblem Health Insurance
10.2011 - 08.2013

Customer Service Representative

Emblem Health Insurance
11.1999 - 10.2011

High School Diploma -

Miami Northwestern Sr High School

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YOLANDA HORNE