Senior Customer Service Rep

Monique Kilgore

Malden, MA 617-***-****

adrfff@r.postjobfree.com

Senior Customer Service Representative

Team Leadership Customer Satisfaction Project Leadership

Award-winning professional possessing more than 10 years of experience in the customer service and healthcare fields. A strong background in equipping teams with the leadership needed to complete daily and long-term objectives. A proven track record of planning and facilitating training sessions which directly result in the creation of highly effective, dynamic teams. A proficiency in technologies including XRM, Monument Xpress, Health Connect and Microsoft Office products

Staff Training and Development

Customer Service

Health Insurance Benefits

Compliance Control

Team Building

Process Improvement

Claims

Performance Tracking

Recruiting Life Cycle Leadership

Schedule Building

Call Center Management

Process Improvement

PROFESSIONAL EXPERIENCE

Medford Rehab and Nursing Center, Medford, MA April 2022-

Unit Secretary/ CNA assistant- part time

Performs administrative duties: Answers phones, takes messages for patients

Assists CNA’s by answering call lights, hands out meals to residents and runs errands for residents

Metro Housing Boston, remote February 2022-

Intake Coordinator- Temporary

Requests CORI’s, performs database management on Cori activity, adds referrals for tracking to

Emergency Voucher housing spreadsheet, organizes member files, creates and issues housing vouchers for

applicants and issues housing letters to applicants

Beacon Hill Staffing Group, Beacon Hill, MA

Covid Project Assistant - Temporary January 2022- January 2022

Labeled and packaged Covid testing kits to ship to other staffing sites

Mock Trial Jury, remote

Mock Juror participant - Temporary December 2021-December 2021

Participant in a mock trial: listened to arguments, wrote notes, asked questions, and deliberated a verdict

Ernst & Young, remote

Project Assistant - Temporary October 2021- October 2021

Conducted surveys on businesses usage of software to track field technicians, for billing and invoicing purposes

Healthcare Financial Inc., Quincy, MA

Member Advocate - Temporary August 2021- September2021

Conducted inbound and outbound calls to members to check eligibility for SSI/SSDI

Filled out SSI applications for eligible members, and conducted medically complex screenings

NTT Data, Quincy, MA

Customer Service Support May 2019-August 2021

Answered provider inquiries regarding member benefits, claims, appeals and credentialing for Commercial,

Medicare and Passport Connect products

Provided job shadowing for new Provider Service representatives

Tufts Health Plan, Watertown, MA September 2011 –May 2019

Enrollment Specialist, September 2017 – May 2019

Performed an in-depth analysis and reconciliation for updated membership data received from the state, as well as, membership profile information within Monument Xpress.

Mitigated any potential errors or delays by rapidly identifying and resolving any discrepancies or errors located within member data during the enrollment process.

Delivered satisfaction by delivery of prompt responses and solutions regarding urgent issues encountered by customers, small business employers, and the health connector.

Provider Service Team Lead, January 2016 – September 2017

Subject matter expert used to update documentation during the development of a new documentation resource (Support point).

Delivered comprehensive training and development to staff (including the Senior Provider Services Representative, Account Specialist, and new employees) which resulted in the assembly of highly effective teams.

Collaborated with the Quality Assurance department during the completion of business initiatives, and the tracking and enforcement of performance standards.

Identified areas of improvement in staff progress and performance which directly resulted in significantly improved quality scores for temporary and permanent staff.

Traveled to Halifax, Canada, assisted the training team, and customer service representatives regarding NTT Data call center protocols.

Resolved escalations internationally and locally

Implemented training sessions on department needs for the new computer system Core Health Rules Migration (CHRM)/HRP system

Awarded with the You Make a Difference Award due to the planning and launch of a one-week training class.

Acquired the Platinum Award and Teamwork Award because of track record of success.

Senior Provider Services Representative, December 2012 – January 2016

Delivered prompt, in-depth responses for in- and out-of-network providers regarding claims status, eligibility, benefits, online references, and provider contract status for Medicaid products.

Ensured the timely completion of physician changes and the adjustment of paper claim correspondences.

Provider Services Representative, December 2011 – December 2012

Responded to provider inquiries regarding member benefits and eligibility within a fast paced, high volume call center environment.

Enrollment Specialist TMP – Temporary, September 2011 – December 2011

Maintained the highest level of accuracy while processing Medicare applications for potential and existing customers.

Directly led the completion of multiple special projects designed to facilitate data entry cleaning for the Diamond database.

EDUCATION & CREDENTIALS

Bachelor of Science in Management, Minor in Information Technology, Bentley College

Masters Health Administration, Suffolk University

MBA Graduate Certificate in Healthcare Management, Fitchburg State University

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