Customer Service Health Care

Triniece Rozier-Sheidun

**** ** ****** ****, ********, OR 97266 503-***-**** ********@*****.***

SUMMARY OF QUALIFICATIONS

Results-driven professional with over 20 years combined experience in serving in a wide range of health care administration roles

Strong focus on creating business process improvement programs for fast-paced customer service organizations

Knowledge of health care management for Medicare plans, process innovation and implementation

Ability to establish call handling standards and service level criteria, and issues management by creating performance monitoring systems to meet customer expectations.

Outstanding health care insurance expertise with strong customer service skills

Proficient in handling complex tasks while being highly trustworthy, discreet, and ethical

Strong analytical skills coupled with a commitment to excellence and the ability to drive efficiency performance improvement

Excellent ability to clearly and effectively communicate with diverse populations in written, verbal, and presentation formats

Able to manage large caseloads including assessing, counseling, mentoring, advocating and referring clients and members to community resources.

Proficient in Microsoft Office (Word, Excel, PowerPoint), Epic, Spreadsheets/Databases, and Microsoft Windows

EDUCATION

Capella University, Minneapolis, MN, 2018

Master of Science Degree in Human Behavior

Concordia University, Portland, OR 2012

Bachelor of Arts Degree in Health Administration

EXPERIENCE

Kaiser Permanente, Portland, OR

Health Plan Member representative 2005 – 2022

Applies and regularly leverages expert knowledge of Federal, State, Medicare policies/regulations, and mandates pertinent to Health Maintenance Organizations, delivery of medical care, and insurance coverage

Educates members about health plan products and available services and advises members on enrollment and eligibility

Determines members’ eligibility for services and resolves enrollment discrepancies

Establish policies and procedures to enable the company to operate efficiently within defined business processes

Facilitates resolutions to gaps that may result from new or revised program benefits, policies, and procedures for enrollment due to legislative changes affecting Medicare and/or Medicaid beneficiaries

Prepares written responses to technical inquiries on various aspects of the law, regulations and procedures

Researches and compiles issues in MACESS to generate reports used by management to identify patterns of member feedback.

Documents, resolves, appropriately triages member complaints, concerns, and compliments according to departmental and Medical Office policies and procedures

Updates Kaiser Permanente systems to reflect corrections/changes to PCP and other demographic information

Initiate communication between Membership Service and medical/dental operations to ensure information that may affect members is clearly transmitted

Actively communicates changes in Medical Office policy and procedures to Membership Service in order to update knowledge information systems

Interacts with multiple KP departments (e.g., Claims, Patient Billing Services, Sales and Marketing, Member Relations, Membership Administration, medical/dental operations, etc.)

Assess member needs, respond accordingly in potentially volatile situations and act appropriately to resolve issues

Triniece Rozier-Sheidun Resume, Page 2

Transition Projects Inc., Portland, OR

Employment Center Coordinator 2003 – 2005

Developed and nurtured partnerships with local businesses to create employment opportunities for Jean's Place residents.

Created individualized employment case plan for residents

Advised residents through employment process including writing resumes and developing interviewing skills.

Managed caseload of 55 women

Accurately updated monthly reports and case management paperwork

Supervised and trained employment center volunteers

Consulted with hiring managers to determine current and future recruitment needs

Processed paper work, created reports, and scheduled team meetings

Prepared program budget with executive director and fiscal officer

Monitored program expenses to maintain and control spending

Utilized all available funding and verified that all expenses are appropriate

ChangePoint Inc, Portland, OR

Admission Specialist 2000 – 2003

Maintained clients’ data files and scheduled clients intake

Networked with agencies in the community to provide clients with additional resources

Obtained information from clients via phone, mail, and in person

Coordinated with team to ensure smooth planning for clients with mental and physical disabilities.

Volunteers of America – Common Bond, Portland, OR

Parent Educator 1997 – 2000

Provided case management, tracking, and follow-up for 35 teen parents

Scheduled and facilitated daily home visits

Identified client strengths and needs to create goals and long term developmental plans

Provided referrals and information to community resources

Implemented and taught culturally sensitive parenting and life skills classes.

Performed detailed assessment for the urgent need of families and developed appropriate service plan to increase and strengthen the family situation based on social, mental, and physical family needs.

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