Operations Representative 2
Resume:
Patrice L Romain
Louisville, KY 40214
ad5q4t@r.postjobfree.com
Experience Humana Consumer Operations Representative 2 September 2023 – Present
The Consumer Service Operations Representative 2 represents the Dual Eligible Outreach Department responsible for taking inbound calls with members that have Medicaid and Medicare regarding the variety of issues. Providing members with recertification education about how they might be affected with specific benefits and choices for Medicaid/Medicare, also providing education about Part A and or Part B with Medicare. Providing education when members are deeming close to loosing Medicaid referring member to either DMS License Sales Agent or to their state to re-qualify for a new plan. Use different vendor operation such EASE, CI, Edge, CRM Sales Force to complete Medicaid and Federal resource programs qualified applications. Screen and assist applying recipients for Medicaid eligible programs, provide social service resource information. Utilize multiple tools(Microsoft: Word/Teams/Excel/Outlook) daily to communicate with DEO Support and DEO Leadership regarding Qualifying applicants applications.
Experience Humana CIT Representative 1 October 2019 – September 2023
As an Inbound and Outbound Contacts Representative 1, working as part of the Clinical Intake Team (CIT) responsible for building authorizations including Behavioral Health, Inpatient, Outpatient, and Medical. Performs follow up with provider/members which includes Medicaid and Medicare benefit questions and resolving issues and some education regarding Humana policy using tools such as Mentor. As a CIT Representative ensures responses to inquiries are completed in a timely manner to achieve customer service quality standards. Annotate details of inquiries, comments or complaints to take action according to policy. Escalates any unresolved and pending customer grievances.
Experience April 2019 to September 2019
Taylor Communication, Jeffersonville IN
Warehouse Worker
Responsible for ensuring cleanliness, tidiness and safety of work environment. Load and uploading delivery vehicles. Accepting delivery of inventory. Counting and confirming inventory. Inspecting inventory. Inspecting inventory for damage and faults. Communicating error to relevant parties. Marking and labeling stock.
Experience
(AFSCME), Louisville KY July 2018 to March 2019
American Federation of State, County and Municipal
As Office Manager, prepared reports, memos, letters, handled information requests. Prepared correspondence. Arranged conference calls. Scheduled meetings. Attended meetings to record minutes. Greeted visitors and determined whether they should be given access to specific individuals. Ordered supplies. Maintained records management database systems. Received and sent departmental packages. Answered and screened incoming phone calls. Provided phone assistance. Knowledge sets include: scheduled meetings, typed correspondence.
Award
Star Award February 2022
Skills
CGX, Mentor, Microsoft Excel, Word, and Power Point
Education
Bachelor of Science (Finance), University of Phoenix
Military
United States Navy May 1980 – June 1992
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