Redesha Hill

Brooklyn, NY

ad4umg@r.postjobfree.com

+1-347-***-****

WHEN IT COM ES T O CUST OMER SER VIC E GIVE M E A 5 STAR CONSIST ENTL Y MEET I NG CUST OMER S'

EXPECTA TI ONS GOING AB OV E AND BEY OND T O KEE P THE CU ST OM ER HAPPY. SE EKING A CHA LLENGIN G YET R EWAR DING R OLE WHER E I CAN USE MY 1 0 YEAR S OF EXPER IENC E PR OVIDING F AST, ACCUR ATE AND

EMPA THETIC SUPPOR T TO A WIDE R ANGE OF

CUSTO MER S

Work Experience

Claim Specialist

BlueCross BlueShield - New York, New York

January 2020 to December 2023

• Handle all customer damage claims and relevant queries promptly and with professionalism.

• Investigate claims and obtain relevant facts to determine coverage, loss, and liability.

• Interact effectively with customers, insurance agents, attorneys, and other public personnel involved in the claim process.

• Assist Supervisor in analyzing, planning, decision-making, and problem-solving activities to support claim settlement.

• Document claim file activities in an accurate and timely manner.

• Resolve claim issues promptly and follow up on outstanding issues.

• Perform negotiation with the claimant to achieve claim settlements.

• Communicate claim status to supervisor, customers, and body shops on regular basis.

• Contact outside agents for claim investigation if needed.

• Perform claim assignments received from Supervisor in a timely and accurate manner.

• Work under the guidance and assistance of Supervisor to ensure accurate claim settlement.

• Be an active team player. Must be able to communicate and collaborate constructively with other internal departments to ensure the job gets done.

• Manage claim settlements within authority limits. Medicare Retentio N Manager

Aya Healthcare - Brooklyn, NY

January 2019 to December 2020

• Manage a wide range of existing Medicare customer retention initiatives; evaluate current success, identify gaps, recommend improvement opportunities

• Identify new and innovative programs and initiatives, designed to strengthen retention rates as well as improve customer satisfaction.

• In partnership with Director of Medicare Retention, delivering comprehensive plan that delivers on the strategies to maximize customer retention.

• Monitor best practices for retention across the Medicare industry; evaluate current industry benchmarks, and work to establish modification or new standards for Healthfirst are in place, reviewed and monitored

• Manage and monitor vendor programs aimed at market growth and enhanced customer experience, including monitoring grievance and appeals issues and trends.

• Establish, develop, and enhance meaningful and appropriate key performance indicators; ensures KPIs including but not limited to quality, productivity, and dependability requirements are met or exceeded through direct/indirect leadership.

• Build strong relationships and collaborates with internal partners, including Marketing, Market Research, Customer

Insights, Enterprise Analytics and EDS to ensure retention activities are coordinated and consistent, and meet business objectives.

• Works with Corporate Compliance to ensure adequate controls are in place, reviewed and monitored appropriately.

• Establishes and communicates daily/weekly/monthly/annual priorities, expectations, and general departmental/corporate communication(s) to improve overall customer experience levels/KPIs /general Healthfirst knowledge.

• Provides status reports to management on all assigned activities, including but not limited to inventory, Service Level

Agreements (SLA), active campaigns, department and employee concerns, customer service and sales related issues.

• Stay abreast of key State and Federal program proposals and changes. Partner cross functionally with Regulatory and other departments to implement program changes ensuring that the team understands the member and financial impacts of the changes.

• Ensures self and team adhere to local, state, federal and Healthfirst specific compliance and regulatory guidelines. Responds to any requests for information or audits timely and accurately. Client Service Respresentiv E

The Law Office of Spar & Bernstein - New York, New York January 2019 to December 2019

• Make outbound calls to prospective clients to sell services

• Generate new business through social media outreach and audience engagement

• Act as the primary point of contact for prospective clients acquired through social media efforts from first social media engagement to first consultation

• Manage online discussions by listening and responding to users (where appropriate) in a timely and authentic manner

Office Manager

X-Ray Radiology - New York, New York

January 2018 to December 2019

· Organizing and directing the daily work Radiology New flow

· Dispatching Technologist

· Creating staffing schedules

· Hiring new employees

·Scheduling Exams

· Maintaining company equipment

· Updating and maintaining documents for the Department of Health

· Collaborating with physicians, radiologist and technicians

· Staffing

· Acting with honestly and integrity in all business transactions, including, but not limited to, employment applications/resumes, patient records, time records, and financial transactions. Office Executive Assistant

Fulton Park Plaza - Brooklyn, New York

January 2017 to December 2018

• Partners with management in the planning, scheduling, coordination and reporting of activities to ensure that projects, goals and objectives are accomplished on time and within budget.

• Monitors budgets and grant allocations and maintains accruals. Prepares documents required to maintain balanced accounts for review and approval.

• May maintain departmental employee files and ensures compliance with regulatory standards. Initiates and follows through on human resources and payroll transactions. Generates weekly payroll submission. Maintains liaison with human resources and payroll to coordinate and resolve issues and problems.

• May coordinate administrative, secretarial and/or general office support coverage.

• Assists in the development and coordination of informational packets for participants. Transcribes and distributes minutes.

• Ensures adequate restocking of supplies for the department. Takes inventory or examines merchandise to identify items to be reordered or replenished.

• Coordinates meetings and appointments and maintains supervisor's calendar.

• Makes travel arrangements and accommodations.

Prepares travel reimbursements and expense reports.

• Screens and prioritizes incoming mail for needed action and follow-up. Responds to mail where appropriate or distribute mail requiring attention to appropriate individual(s).

• May assist supervisor with the completion of grant applications, special projects and Joint Commission and other survey preparations.

Call Center Agent

NetCost Market - New York, New York

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Manage all incoming and outgoing calls in the organization. Build long-lasting relationships with customers.

Be informed that NetCost Market keeps a comprehensive record of all calls and/or conversations in the organization’s call center data bank.

Attend educational seminars or conferences on a regular basis so as to develop expertise and improve performance levels.

Make sure that whatever response given to the customer(s) is in line with pre-organized communication scripts that have been prepared for different topics that cover customer-related issues. Identify the needs of various customers, clarify information, embark on necessary research, and provide lasting solutions to customers’ problems.

Route calls to the appropriate channel(s)

Forward complex issues or complaints to supervisors Work during extended odd hours and/or during holiday periods Obtain, verify and enter client information by answering telephone calls and interviewing clients. Determine customer eligibility by comparing client information to requirements. Inform clients by explaining procedures, answering questions and providing information. Maintain communication equipment by reporting problems. Maintain and improve quality results by adhering to standards and guidelines. Update job knowledge by studying new product descriptions and participating in educational opportunities.

Accomplish the company mission by completing related results as needed. Provide customer service support for online reviews and reputation management through phone calls and e-mail correspondence.

Cooperate with other departments in order to work with the company efficiently (stores, GMI, delivery service, etc.)

· Cooperate and communicate via different channels with drivers regarding deliveries, routes and customer requests

Skills

• Persuasive Speaking Skills

• Professionalism, Patience, and a “people-first” attitude Redesha Hill STAR CONSIST ENTL Y MEET I NG CUST OMER S’ EXPECTA TI ONS GOING AB OV E AND BEY OND T O KEE P THE CU ST OM ER HAPPY . SE EKING A CHA LLENGIN G YET R EWAR DING R OLE WHER E I CAN USE MY 1 0 YEAR S OF EXPER IENC E PR OVIDING F AST, ACCUR ATE AND EMPA THETIC SUPPOR T TO A WIDE R ANGE OF CUSTO MER S

• Effective Listening

• Active Listening Skills.

• Interpersonal Skills

• Clear Communication Skills

• Time Management.

• Building Customer Loyalty.

• Attention to Detail.

• Positive Attitude.

• Adaptability

• Improving Customer Experience.

• Medical Records

• Pricing

• Recruiting

• Nursing

Certifications and Licenses

CNA

HHCNS-BC

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