Eligibility Specialist Customer Service
Resume:
Debra McKelvin
*************@*****.***
Objective: Seeking a position utilizing my Administrative/Office, Medicaid, Customer Service and Quality Assurance Specialist skills to become an asset to any company that requires professionalism and dedication.
EXPERIENCE: Highly skillful with years of Administrative and Customer Service experience. I have provided three years of Medicaid eligibility, enrollment, call Center and Quality Assurance experience.
PROFESSIONAL ACCOMPLISHMENTS:
4/6/2016-Present-
Maximus/Customer Service Representative
Assist Consumer with completing application for healthcare in compliance with the ACA (Affordable Care Act)
Provide resources and information pertaining to the status/update of the application.
Following the state guidelines and policies in which the application and information is required.
Enroll and Process applications for the states of CT
Being available to the consumer to provide a service that makes them comfortable and secure while also providing telephone numbers, websites and a variety of offices to support their individual needs.
6/3/2014-4/6/2016
Maximus/Randstad Staffing Agency
Quality Assurance Specialist
Create unlimited customized Quality Assurance evaluation templates; review calls and score agent performance during call recording playback with user-defined questionnaires.
Split screen search results page - listen to recordings and view videos (where applicable); simultaneously work through scoring templates.
Scores can be numerical values, Yes/No answers, and single or multiple responses from a default set or defined by the user.
QA software automatically tallies final scores based on customizable targets for Quality Assurance pass/fail criteria.
Use rules-based call selection to capture an unbiased, random sample of calls per agent.
Notes can be added to evaluations for Quality Assurance coaching purposes that address agent performance.
Email evaluation results to agents for review with or without associated recordings.
Enhance coaching to improve agent productivity, policy adherence/compliance and customer satisfaction.
Supervisor performs evaluations, scores are automatically tallied, results and notes are compiled.
11/15/2013 – 6/3/2014
Maximus/Randstad Staffing Agency
Enrollment Specialist/Customer Service Representative
Assist Consumer with completing application for healthcare in compliance with the ACA (Affordable Care Act)
Provide resources and information pertaining to the status/update of the application.
Following the state guidelines and policies in which the application and information is required.
Enroll and Process applications for the states of CT, DC, MI, KS and PA
Being available to the consumer to provide a service that makes them comfortable and secure while also providing telephone numbers, websites and a variety of offices to support their individual needs.
12/15/12 – 11/15/13
Maximus/Randstad Staffing Agency
IL Medicaid Redetermination Eligibility Specialist
Utilized electronic data verification to aid in the timely redetermination of medical eligibility to the State of IL.
Responsible for processing cases i.e., AABD, Moms & Babies, FHP, Medical Extension cases, High Priority, Routine, Med + Ben (Medical + Benefits) TANF, Family Assist and Rebate cases.
Utilized the HMS (Integrimatch) Data Matching System to generate Information Request Notices to clients requesting documents and also retrieving documents to calculate income necessary to make a recommendation.
Located citizenship verification via WTPY and IDPH to validate IL citizenship.
Worked with SDU website to validate Child Support received and paid.
My role and partnership with the State is to ensure that we are processing certain redetermination cases (that have been defined by the state).
Familiar with policy guidelines for DHS and HFS Medical Groups.
7/23/10 – 5/25/2012
Northwestern College
Student Worker/Financial Aid
Maintained and organized approximately 1000 confidential student files
Proficient at managing and handling sensitive and confidential student loan information
Supervised student mass mailing groups for student exit interviews notification
Created system to effectively transform student body paper files into electronic files
Successfully juggle multiple tasks in a fast-paced environment at own initiative as well as at supervisor’s discretion
Efficient at working well with others and solving inter-office conflict
Provide resources to students on financial development seminars, conferences, and conventions
Advising students on available assets available at the school like counseling, mentoring, tutoring, etc.
EDUCATION:
Northwestern College
Major: Criminal Justice
Assoc. Degree in Applied Science
Graduation – June 2012
3.8 GPA/4.0 SCALE
Alpha Beta Gamma (Honor Society)
Commencement Speaker of Ceremonies
Member of General Education Board of Directors
Computer and Other Skills
Advanced skills in Microsoft Word, Excel, and PowerPoint. I have experience with QuickBooks and Quicken software, also experience with Donations software, i.e., Donor Perfect and E-Tapestry. I type 70 WPM. I also have 10-key and lockbox experience. I have experience with TeleStrat, CRM, Worker Portal and working dual screens in my experience as a Customer Service Representative, Eligibility Specialist, Quality Assurance and Debt Collections.
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