Customer Service Mental Health

Michael Trimble

Portland, Oregon ***** Phone: 503-***-**** E-Mail: ********@******.***

12+ years of experience in Customer Service

* **** ** ******* ********* manager overseeing 900 agents

* ***ths as interim team leader managing 30 agents

6+ years of experience in a Call Center as well as 6+ years working remotely

9 months of timely review, investigation, and adjudication of all types of Medicaid, Medicare, Group or Individual medical, dental, & mental health claims.

EDUCATION

Bachelor’s Degree in Political Science - Duquesne University

SKILLS

Proficient with a vast array of computer skills, concepts and technologies

Inbound, outbound & cold calling

Sales, Upselling, Cross Selling, Recruiting

Technical Support: troubleshooting hardware and software

Adobe Connect Certified including other virtual related platforms (X-Lite, Skype, Zendesk, Citrix, Superset)

Microsoft Windows Word, Excel, OneNote, PowerPoint, Outlook, Teams

Photoshop--Premiere Pro (video, photo, audio editing)

EXPERIENCE

CareOregon

Claims Examiner Level II January 9 - November 16, 2023

•Adjudicated medical, dental and mental health claims, and/or re-adjudicated or adjust/correct, claims including some complex and difficult claims, in accordance and/or compliance with plan provisions, State/Federal regulations, and CareOregon policies/procedures

•Called providers to gather additional information to adjudicate claims timely and effectively providing excellent customer service to internal and external customers based on Department and Company standards

•Utilized CareOregon on-line phone tracking system to document all activities from any mode of communication as well as claims payment system to effectively adjudicate medical claims, or re-adjudicate or adjust/correct medical claims, and generated letters and other documents as needed defined by CareOregon and Claim Department policies.

•Made determinations of eligibility, benefit levels, coordination of benefits with other carriers, recognized and investigated third party issues which often required working with attorneys or outside agents

•Reviewed and processed refunds which often resulted in posting refunds and claim adjustments or re-adjudication.

Inbound/Outbbound Customer Service March 9, 2020 - January 6, 2023

Research, verify and resolve inquiries relating to Oregon Health Plan or Medicare eligibility

Respond and assist members with Primary Care Provider (PCP) assignments.

Work collaboratively with providers, DMAP, members to ensure effective customer service and the resolution of health plan problems (i.e., eligibility and system) as needed.

Use online Call Tracking system to document all activities from any mode of communication from members, providers and other customers.

Coordinate mailing of member materials

Make outbound calls to Medicaid or Medicare members including welcome and retention calls.

Bud Clark Commons (Home Forward managed property) (on call) June 2019-February 2020

Resident Specialist

`•Support, interact and communicate with residents who have special needs including mental or physical disabilities and/ or substance abuse issues. Answer and respond to resident concerns and questions regarding lease compliance, safety, disturbances on site, noise or unauthorized guests or other issues impacting residents or the community.

•Perform activities in support of resident Residential Services Plans ensuring Resident and Community Services Coordinator(s) and/or other appropriate staff is kept informed of resident behavior. Compile accurate and appropriate information on resident behavior; ensure complied information is integrated into resident service charts and/or the Residential Services Plan as needed.

•Work closely with security staff to ensure resident and community safety. Routinely patrol building interiors, exteriors and perimeters; maintain security logs and/or visitor check in/out logs as needed.

•Respond to resident lockout service requests; complete related paper work as needed. Assist residents with maintenance service requests and work orders; input service requests into appropriate database.

White Spider Rental Concierge September 2016-February 2019

Reservations Agent

• Replied to prospective and current guests approving/declining reservations based on subjective and objective criteria, answering questions, and/or amending reservations through a combination of Guesty, email, AirBnB platform, or phone

• Provided customer service by taking calls from prospective and current guests through a combination of RingCentral and/or Sideline as well as responding through text messages

• Scheduled cleanings for each reservation through SubItUp, as well as provided support to the cleaners coordinating their schedules

Direct Action Partners April 2016-September 2016

Signature Validator

•Verified on state ballot initiative signature sheets against the voter registry database

•For signatures unmatched signatures were manually added to the database

•Analyzed the data from canvassers (i.e. validity rate, signatures per hour against hours worked) compiling the data into two master databases

Uber (Work from Home Independent Contractor) November 2014-October 2015

Driver Support CSR

•Responded to email inquiries from drivers regarding applications, adjustments, missing payments, and other driver related matters using Zendesk, Microsoft Office, and other company proprietary software

Alpine Access March 2012-June 2014

Quality Assurance Team Manager

•Took inbound calls from telecommunications customers who were delinquent or past due on their bills. Processed payments on behalf of the customers and negotiated payment arrangements on customers’ past due balances to avoid termination of services and/or restore cancelled/terminated services

•Performed troubleshooting on all devices serviced by the telecommunications company including diagnosing network outages and network upgrades. Provisioned devices including updating/changing resources internally as well as configuring monthly recurring charges/price plans in accordance with device/provisioning requirements and policies

•Monitored live and graded recorded calls to maintain high quality assurance standards for the program overseeing 900 employees issuing reports and corrective action plans to bring employees not meeting metrics into compliance analyzing customer surveys compiling data and exporting to various data bases working closely with team leaders to improve customer service and satisfaction on calls handled insuring first call resolution

•Called back customers who indicated dissatisfaction with the reps’ offered resolutions or disagreements with company policies and protocols on their surveys seeking further resolution at managerial level as well as handled real time escalations from customers threatening legal actions, filing complaints with the Better Business Bureau or related pro-consumer organizations, wanting to contact Corporate/CEO, go to the press or the attorney general, or wage a social media campaign against the company due to dissatisfaction with the resolution supervisors’ offered resolutions or disagreements with company policies and protocols; these calls were handled in real time to prevent from going further to executive

•Managed a team of 30-35 customer service representatives in addition to proving floor support for 40 to 60 representatives as a subject matter expert answering their questions and assisting them with their calls by directing them to the appropriate data knowledge bases relevant to their calls maintaining high quality standards.

Contact this candidate