Customer Service Rep
Resume:
• TONYA LOMAX
***********@*****.***
EDUCATION:
● Associates Degree in Applied Health Science, with focus in Massage Therapy, GPA 3.5 (completed) EXPERIENCE:
WellCare Health Plan- Centene Corporation, Tampa FL 2022-Current
Senior Customer Service Rep II to Escalation Response Specialist III
• Responds to complaints and escalations from members. Handles escalations, handling problem tickets, and providing feedback to leadership regarding member issues.
• Provides timely and appropriate resolutions to escalated issues received from different communication channels
• Acts as a liaison in maintaining relationships between departments to ensure timely and appropriate issue resolution
• Documents, tracks, resolves, and responds to all assigned complaints and inquiries in writing and/or by telephone in a timely and professional manner
• Conducts and monitors root cause of member issues to identify trends across the enterprise, and works cross functionally with all departments to ensure enterprise-wide solutions
• Coordinates with contact center team to research and review underlying facts of escalated inquiries, determine validity of complaints, and evaluate options to remedy these complaints
• Leverages complaint trends to develop recommendations that are designed to enhance member experience and reduce complaints and escalations
• Provides timely status update reports to members and internal Departments to support transparency and improve the customer experience
• Maintains up-to-date knowledge of our products and services to provide accurate and effective support to customers
• Performs other duties as assigned
• Complies with all policies and standards
I also participated in the Q1 2023 Job Shadowing Program, headed by Sandi Geary with a goal to create the very best experience for everyone, share knowledge, build relationships across the organization, and provided to enhance career development. I specifically selected Quality Assurance Job Shadowing Session 4: Senior Quality Specialist. We had weekly 1 hour sessions from January 16th through March 24th.
The Host Organization is: Quality Assurance (MPS)
The Hosts: Marc Brown, Yohara Torrens, Taheerah Rounds, Jimmy Johnson, Lia Blanco Shadow Day Topic 1 Hour sessions Session Learning
Meet and Greet Get to Know the Shadowees
• What is your role at Centene?
• How long have you been with the company?
• What would you like to learn about Quality?
• Why did you choose Quality to Job Shadow?
• What is a fun fact about yourself you
wouldn’t mind sharing?
Session 1 Introduction and Overview of Quality
Session 2 Quality specialist I Quality Auditing Process Session 3 Quality specialist II
Quality Development Structure, Rebuttal
Process, Support for Other Business Units and
Training
Session 4 Senior Quality Specialist
The responsibilities of a Senior Quality
Specialist: 1) Meetings (Huddles, Rebuttals,
Leadership), 2) Tasks (Mailbox, SharePoint site,
Assignments), 3) Audit the Auditor Process
(Scoring, Pace, Process), 4) Contact Center
Operating Model (Health Plan Guidelines,
Contact Center Guidelines, Impact
on QA process) and 4) Presentations (CSR New
Hire, Quality New Hire and Calibration
Meetings)
Session 5 Vendor Auditing
Line of Business considerations, Vendor
Requirements, Onboarding New Vendors,
Providing Support to Vendors, Vendor Audit the
Audit Process, Contract Implications)
Session 6
Our Vision for the Future, Change
Management, Wrap and Questions &
Answers
Peachstate Health plan/Centene Corporation, Marietta GA 2018-2022
Member/ Provider Services Representative
● I provide excellent customer service by taking high volume inbound calls for Ambetter Peachstate Health Plan, pertaining to policy and benefit information. I take payments and make follow up outbound calls. I have been promoted to work with Providers on Medical Claims for Ambetter Peachstate Health plan, As well as for GA Medicaid. I have assisted in one-on-one training to new hires, as well as my calls being used as a module/guideline to Ambetter training classes. I speak with Medical Providers daily, to not only provide claim status & information, but also for Coordination of benefits, Member Benefits, Eligibility. I also provide contact information for Provider Relations Representatives as well as for any contact updates. I give basic technical support when needed.
● Proficient computer skills & knowledge of Microsoft Applications, such as Word & Outlook. Proficient with Citrix systems, Avaya, Omni, Amysis, Cenpass, Slack. Efficient with Excel.
● Excellent written and verbal communication skills.
● Excellent interpersonal skills with proven ability to influence, defuse, reconcile, & remedy in professional situations.
● Demonstrated aptitude for active listening, critical thinking, and problem-solving skills.
● Proven track record of superior customer service skills. 20+ years’ experience.
● Ability to work independently, efficiently, & meet all internal/external time commitments.
● Experience & high level of comfort using web or mobile technology.
● Demonstrated ability to quickly learn new technology & a desire to solve problems professionally & proficiently. I also participated in the Q1 2023 Job Shadowing Program, headed by Sandi Geary with a goal to create the very best experience for everyone, share knowledge and build relationships across the organization. Wipro, Atlanta GA
2018-2018
Customer service representative
● Tier 1 Geek Squad agent for Best Buy that assisted customers with computing devices customer service issues or technical troubleshooting
● Experience with Windows Operating Systems, Microsoft Office, Internet Explorer, Mozilla Firefox, and Google Chrome
● Experience with Macintosh Operating Systems, Safari, browser plug- ins, and personal security Software Friendship Industries, Harrisonburg VA
2016-2017
Warehouse Team leader
● Oversee group whom assemble, package and ship out a medical supply and military kits
● Take inventory, keep records and up to date documentation on all production
● Pack and ship merchandise or supply
● Created and used Excel Spreadsheets for documentation purposes
● Coordinated with USPS or UPS/DHL daily for shipping Arise- Disney Dining Charlotte NC
2015-2016
Cast Member/Call Center Representative
● Took inbound Customer Service calls and assisted in finding availability and making dining reservations for Walt Disney World guest
● Answered many different inquiries involving dining and events at Walt Disney World Resort Rosetta Stone Warehouse, Mt. Crawford VA
2014-2015
Production Assistant
● Production line worker
● Put together packages and product to be shipped out
● Did inventory
● Scanned, taped and boxed finished product
Sysco, Harrisonburg, VA
2014-2014
Office Assistant
● Answered telephones
● Helped direct calls
● Filed documents
● Helped organize payroll
● Pick up and drop off in mailroom
● Used fax machine
● Pay bills
● Helped drivers with route information
● Communicated through email
APAC Customer Services, Inc., Newport News VA
2006-2013
Customer Service Account Representative
● Handled any inbound Customer Service calls relating to scheduling pickups for UPS packages ● Opening and discussing different accounts for customers and business depending on their needs.
● Making changes to already existing UPS accounts.
● Data Processing
● Email communications
The Faneuil Group, Newport News, VA
2002–2006
Sales Representative
● Analyzed existing Verizon business accounts.
● Consolidated client bills
● Coordinated client bills within local, regional, long-distance areas, along with Toll-free services
● Organized phone set up for numerous clients
● Helped create and incorporate a user-friendly scripted guide for Agents to use on calls Worldwide ● Outbound calling and up-selling
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