Sales Customer Service
Resume:
Carol A. Hines
Bronx, NY 10473
Home: 718-***-****
Cell: 954-***-****
Work: 718-***-****
E-Mail: abijcg@r.postjobfree.com
OBJECTIVE To secure an entry-level position that will give me the
opportunity to utilize my communication and excellent customer
service skills with an ability to work
effectively with people in a variety of fields.
QUALIFICATIONS
o Possess New York Health and Accident Agent License(42 other states)
o Extensive public contact and over 7 years experience.
o Great communication skills and the ability to resolve differences.
o Reputation as a sufficient and accountable employee.
o Good analytical, researching and writing skills.
SKILLS Software: Microsoft Windows 7, MS Windows XP
Professional Edition, Internet Outlook, Lotus Notes, Microsoft Office
(Word, Excel Access, Powerpoint), Novell, Faxcom (electronic faxing),
Facets, CCMS (Care Enhance Clinical Management Software), Emevs and
Epaces (Medicaid Verification).
Office Skills: Typing 40 WPM, alphanumeric and chronological
orders of files, 6,000 keystrokes, medical transcription, refined
knowledge of office procedures-filing, faxing, scanning answering phones,
UPS, USPS and FedEx shipping and receiving, Access postage meter
machine, Xeroxed numerous documents at fast pace, ability to deal with the
public and ability to adapt to a variety of work environments very
quickly.
LICENSES & Florida State Drivers License Class E
CERTIFICATE Issued: 02-14-08 Exp: 02-15-2012
Department of Financial Services
Health and Accident Agent License Issued: 06-2005(Florida
Resident)
Health and Accident Agent License Issued: 11-2005(Non-Resident
in other 43 states)
American Heart Association
Healthcare Providers (CPR & AED) Program completion 07-26-
2010 Exp: 07-26-2012
EXPERIENCE
03/2009-Present Affinity Health Plan
Bronx, NY
Clinical Outreach Specialist/Medical Management
Coordinator/Safety Liaison
Special Care Program (HIV and AIDS)
o Responsible for obtaining information concerning
member/patient's physical and psychosocial needs.
o Work with Nurse Case Managers to ensure that appropriate
treatments and care plan services are implemented and authorized.
o Obtain information from members concerning the health
status, reinforcing health education, scheduling and authorizing of
services for members, tracking services provided to members,
information management and quality improvement.
o Integral part in the care management team and works
closely with the case managers in providing translation and support
to the team.
o Conduct clinical initiative outreach calls and send
outreach letters to members and/or providers involving review of
clinical information processed within NYS and HIPPA federal
guidelines.
o Identify members who miss appointments for on or off site
services, call and send reminders before scheduled appointments,
assist members with non emergent transportation services and address
potential barriers to care.
o Maintain file integrity with regards to content, location
and confidentiality adhering to department standards and
regulations.
o Inspect and report problems and concerns to ensure the
safety of the department premises and attend training and in services
approved by department director on a monthly basis.
09/2007-07/2008 Amerigroup Corporation
New York, NY
Account Representative-Medicare Sales
Specialist (Telesales)
o Meets sales and sales development goals as assigned by
management.
o Submits enrollment applications in a complete and timely
manner.
o Conducts telemarketing activities, both inbound and
outbound to respond to inquiries, generate appointments, and follow-
up on leads, referrals, and re-marketing opportunities.
Carol
A. Hines
Page 2
o Responds and follows-up on leads which include entry of
data into sales tracking system.
o Coordinates and implements strategies in an assigned
territory and growing membership through face-to-face sales
enrollment meetings, presentations, provider education sessions and
social service outreach to existing and potential members.
o Develops and maintains new contacts and/or partnerships in
the community.
o Conducts in-home presentations and community-based
presentations and performs other activities in an effort to gain
members and maintain and/or established positive relationships with
providers, community and faith based organizations.
o Participates in marketing events and exhibits as needed.
10/2006-03/2007 Touchstone Health
Partnership
New York, NY
Medicare Telemarketing Representative
o Assessed and enrolled all Medicare recipients via-
telephone for membership and benefit eligibility.
o Develop and deliver sales presentations based on customers
needs.
o Maintaining a specific enrollment average and goal per-
month.
o Made 150-200 calls daily to motivate prospects to enroll
in Medicare Plan.
o Scheduled in home appointments per week for outside sales
representatives to conduct in home presentations to prospects
primarily in the Bronx, Brooklyn, Queens and Staten Island.
11/2004-10/2006 NationsHealth d/b/a
CignatureRx
Plantation, FL
Medicare Part D Enrollment Specialist
Member Services & Collections
o Provide online telephone assistance answering questions
and resolving issues regarding claims, benefits, enrollment and
billing by researching documentation, system information and gaining
knowledge from other CignatureRx employees.
o Ability to access information from a variety of systems
and online references.
o Record all encounters in tracking system and assure that
they are followed to resolution.
o Respond to members and/or providers while ensuring a high
level of customer service while adhering to quality improvement
and retaining large amounts of information, facts and compliance with
HIPAA guidelines & regulations.
o Assist members in accessing data in Argus system regarding
claims processed for prescription drug coverage; locate
Explanation of Benefits (EOB), claim references materials, denial
codes and refer member to Grievance and Appeals Dept for
unresolved claims transactions.
03/2003-11/2004 Humana
Inc.
Miramar, FL
Client Specialist/Direct Market Sales
o Communicate effectively using outbound calling system for
prospective members on Senior Medicare Advantage Plans.
o Provide accurate information to Medicare recipients of
current benefits, eligibility and educate on the best use of plan
benefits.
o Responsible for meeting all departmental goals and
maintain productive working relationships with others.
o Assisted in PCP selection and conducting new member
orientations and seminars.
o Perform all job duties to ensure compliance with CMS
regulatory requirements.
o Demonstrated knowledge of HMO/PPO/PFFS insurance plans for
prospective Medicare recipients.
04/2002-05/2005
Convergys
Tamarac, FL
Cingular Wireless/AT&T Wireless
Specialist/CSR
o Handled approximately over 100 telephone AT&T wireless
inquiries in an inbound calling center per day.
o Developed a working knowledge of AT&T wireless policies
and procedures using Macro cell and Axys database.
o Assisted customer with billing and payment arrangements
with major credit cards and electronic checks.
o Provided general information about AT&T wireless calling
plans, services and products.
o Greeted and assisted customers; warm/cold-transferred
calls to appropriate departments as needed.
o Effectively resolved known and unknown technical issues
with handsets with various problem-solving solutions.
EDUCATION
2001-Present Broward Community College
Pembroke Pines, FL
Sophomore status, Major: AAS in Nursing
53 credits prerequisites for Nursing Program
09/94-02/98 Bronx Regional High School
Major: General Ed /Health Occupations
NYS Regent HS Diploma Obtained January 1998
REFERENCES
Available upon request.
Contact this candidate