Inbound tier III associate

Cleon Inverary

301-***-**** ● Tampa, FL **************@*****.*** LinkedIn

PROFESSIONAL SUMMARY

A highly motivated seasoned customer service professional with over 3 years of Individual Medicare & Medicaid Services experience within a production-driven-call center environment.

Performance driven with a passion for solving complex issues and Influencing Outcomes. Seeking a position in a production metric driven environment.

Excellent organizational, interpersonal, and communication skills, both written and verbal.

EXPERIENCE

INBOUND CONTACT REPRESENTATIVE III JUNE 2023 – PRESENT

HUMANA, TAMPA, FL

Maintain company standards while assisting Veterans and non-Veterans, current or new members who are Medicare eligible, providers, pharmacies and internal contacts with claim, benefit, billing, Member Enrollment/Disenrollment, Member Solution, Retail Services Center questions, using multiple computer applications/screens simultaneously.

Dedicated Eligibility Specialist Unit (DESU) trained to resolved pharmacy access to care issues involving plan errors and Extra Help issues.

De-escalate and resolve member calls needing to speak with a supervisor relying on self-accountability and critical thinking as an Account Supervisor.

Assist Behavioral Health members with complex benefit or enrollment concerns and resolving basic customer service needs.

Provide detailed benefit coverage information for Bariatric, Gender Reassignment, and IPA’s.

Display attention to detail and relied on my ability to multi-task. Resolved Healthy Benefits spending Account disputes.

Resolve Humana.com Sign-in Username and Password Assistance Web issues.

Act as a resource and liaison for frontline representatives to assist members with obtaining assistance for overall resolution.

Soultran tranined.

INBOUND CONTACT REPRESENTATIVE II NOVEMBER 2018 – JUNE 2023

Humana, Tampa, FL

Address Group Medicare customer needs which may include complex benefit questions, resolving issues, and educating members.

Records details of inquiries, comments or complaints, transactions or interactions and act in accordance with it.

Escalate unresolved and pending customer grievances.

Followed standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion.

Research prior authorizations processing requests from providers, members, and pharmacies via phone.

Nominated to be on numerous internal projects with a wide range of requests Subject Matter Expert (SME) on Medicaid/Medicare processes, policies, programs, and benefits.

Selected to join the Medicaid Bailout Team.

Selected to join the ARSOS Bailout Team.

Awarded a $500.00 bonus for my contribution toward our 2023 Star ratings.

Member Service Coordinator September 2011 – October 2018

WaveCare Health Services, Washington D.C.

Assisting with meeting branch established goals through individual referrals and reinforcing team member referral behaviors.

Take ownership of member issues when possible, with the assistance of the branch management.

Assists in the training and development of new team members.

Provide answers and assistance for member questions/concerns, utilizing resources within the branch.

Serve as mentor/trainer and provide guidance and assistance to team members.

Analyze problems and provide solutions in coordination with branch management.

Perform other duties as assigned.

Managed contact center agents. Provide coaching, monitored compliance on performance metrics and processes.

Participated in strategy meetings, established specific processes and reports, created process manuals and ensured accurate input of data with-in WaveCare Systems.

Client Service Consultant II January 2006 – September 2011

Covance, Gaithersburg, MD

Responsible for the overall accountability for the day-to-day administrative service support of multiple clients.

Maintain a focus on client service, including responding to inquiries timely and accurately, resolving issues promptly.

Facilitate training sessions for junior team members.

Build and maintain strong relationships with internal and external partners to facilitate issue resolution, operational improvements, and risk reduction.

Process specialized workflows, resolve exceptions, assist with complex inquiries.

Ensure results met in line with procedures, metrics, and benchmarks, while adhering to critical timeframes

Excellent organizational, interpersonal, and communication skills, both written and verbal

Communicates and educates on product features, benefits and contract provision details.

Reference available upon request

Technical Skills

Walden University

Bachelor of Arts Degree, Business Management – in progress

MS Office including Word, Excel, Power Point and Outlook

CRM, CI, and CAS CRM, PMT, Marx and/Litton

Contact this candidate