Customer Service Representative

Tomeika Fain

***********@*****.*** 470-***-**** Atlanta, GA

SUMMARY

Seasoned professional with 20 years of customer service experience seeking a Customer Specialist role. Expert in handling high-volume calls, resolving billing and technical issues, and enhancing customer satisfaction. Proven success in benefits administration, claims processing, and providing comprehensive support in healthcare and technology sectors.

WORK EXPERIENCE

Evicore Atlanta, GA

Member Outreach Apr 2024 - Present

• Taking inbound and outbound calls from members regarding preventative screenings.

• Scheduling appointments for members regarding preventative screenings.

• Assisting members with scheduling transportation to appointments. Magellan Health Atlanta, GA

Benefits Specialist Jul 2022 - Dec 2023

• Manage inbound inquiries from providers and members concerning behavioral healthcare benefits, ensuring accurate information dissemination and high-quality service.

• Facilitate authorizations for Employee Assistance Programs (EAP) and advanced healthcare services, adhering to policy guidelines.

• Supply members with comprehensive provider lists, enhancing their ability to locate accessible healthcare services within their vicinity.

Ceridian Dayforce Atlanta, GA

Customer Service Representative Dec 2021 - Apr 2022

• Resolved customer login and account access issues by providing clear guidance and support for system navigation.

• Informed customers on operational policies, including outlining the limits of overdraft protection (ODP) transactions per pay period and daily allowances.

• Assisted users in effectively utilizing the features and functionalities of the company's proprietary applications, enhancing overall customer experience.

Ascension Health Care Atlanta, GA

Health Care Benefits Specialist Jun 2021 - Nov 2021

• Managed incoming inquiries from consumers and providers, ensuring accurate communication of healthcare benefits and coverage.

• Processed a variety of healthcare claims, effectively addressing consumer needs related to medical procedures.

• Maintained high productivity within a fast-paced call center environment, handling an average of 80 to 125 calls daily.

DeKalb County, GA Decatur, GA

Customer Service Representative Jun 2019 - Jun 2020

• Managed customer inquiries and resolved concerns related to water billing, ensuring accurate account initiation and closure.

• Coordinated with maintenance teams by creating work orders to investigate water leaks and meter malfunctions, enhancing service reliability.

Kaiser Permanente Duluth, GA

Member Services Representative Nov 2018 - Mar 2019

• Addressed and resolved member inquiries regarding medical benefits and claim statuses through both inbound and outbound communication channels.

• Processed plan reinstatements and premium payments for Medicare, Medi-Cal, and individual plans, ensuring accurate billing and member satisfaction.

Vonage Business Solutions Inc. (LE) Atlanta, GA

Customer Service Representative Feb 2015 - Nov 2018

• Addressed and resolved customer inquiries concerning billing and technical issues, ensuring accurate and efficient processing of electronic payments.

• Achieved sales and service objectives by identifying customer requirements and enhancing their experience through product cross-selling and upgrades.

• Provided support to colleagues by answering system-related questions, facilitating knowledge sharing and problem-solving within the team.

Wellpoint Atlanta, GA

Member Outreach and Education Nov 2013 - Jun 2014

• Managed both inbound and outbound communication with Medicaid members to address and resolve Disease Management inquiries effectively.

• Provided educational support and resources to members, enhancing their understanding and management of healthcare concerns.

TRC Staffing Atlanta, GA

Customer Service Representative Jan 2013 - May 2013

• Managed a high volume of inbound calls, ensuring effective resolution of billing and technical issues, while maintaining accurate and prompt processing of customer electronic payments.

• Achieved sales and service objectives by effectively discerning customer needs, promoting appropriate cross-sells and upgrades to enhance customer satisfaction and loyalty. Wipro Technologies Atlanta, GA

Customer Service Representative Jul 2010 - Mar 2012

• Managed the distribution of policy information to health care facilities and verified coverage details for Medicare, Medicaid, and private insurance, ensuring compliance with regulatory standards.

• Resolved claims issues, providing detailed information to service administrators and guiding resolutions to maintain accuracy in service billing and records.

• Contributed to work groups focused on process enhancement, aiming to elevate provider satisfaction, and efficiently coordinated patient documentation, including claims and appeals. Dynamic Research Atlanta, GA

Customer Service / Market Research Assistant Dec 2008 - Jul 2010

• Conducted comprehensive market research and facilitated marketing focus groups, aligning with industry best practices to gather critical customer insights.

• Developed workflow plans tailored to client needs, ensuring efficient and effective requirement gathering processes. Spectrum Services Atlanta, GA

Customer Service Representative Mar 2006 - Oct 2008

• Managed customer inquiries, including account access issues and security updates, ensuring timely resolution of technical problems to maintain client satisfaction.

• Recorded and navigated customer management systems to support market research efforts, contributing to the enhancement of the customer experience.

North America Telephone Network Atlanta, GA

Customer Service Representative Apr 2001 - Dec 2005

• Addressed customer inquiries and resolved issues, ensuring efficient service by maintaining adherence to company policies and protocols.

• Achieved sales targets by identifying customer needs, promoting suitable products and services, and executing cross-selling strategies.

• Enhanced team performance by sharing expertise and providing guidance, contributing to overall professional growth and customer satisfaction.

EDUCATION

Georgia Perimeter College

Associate, Political Science

Decatur, GA

SKILLS

Customer Service • Call Center • Customer Care • CSR • VoIP • Market Research • Active Directory • Computer Networking • Sales Support • Microsoft Windows • Technical Support • VMWare • Salesforce (9 Years) • LMS CRM

(8 Years) • Dayforce • Ceridian • Medical Terminology (10+ Years) • EHR Systems (10+ Years)

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