Customer Service Quality Assurance

FLORENCE, US • ***********@*****.*** • 843-***-****

CAROL JONES

PROFESSIONAL SUMMARY

Customer Service professional with excellent skills as an Eligibility Worker, Claims Processor and Customer Service Representative. I have extensive expertise in processing MAGI applications and performing quality assurance checks within the healthcare sector. Demonstrates strong leadership, critical thinking, and problem-solving skills, leveraging tools like OnBase, CURAM, and Microsoft Teams to ensure accurate eligibility assessments and enhance team collaboration. Committed to continuous improvement and fostering a supportive work environment, contributing to streamlined processes and measurable enhancements in applicant satisfaction.

EMPLOYMENT HISTORY

ELIGIBILITY SPECIALISTApr 2025 - Present

TEKsystems/SCDHHSFlorence, S.C.

Process MAGI applications, ensuring accuracy and enhancing applicant trust.

Maintain detailed records, improving data integrity and decision-making.

Collaborate using Microsoft Teams to streamline workflows and boost satisfaction.

Swiftly resolve application issues, enhancing applicant satisfaction.

Utilize Excel for data management, fostering team collaboration.

Coordinated workflows via Microsoft Teams, significantly streamlining communication and enhancing team collaboration.

Provided exceptional customer service, addressing applicant queries promptly and fostering a positive application experience.

QA TEAM LEADApr 2024 - Apr 2025

TEKsystems/SCDHHSFlorence, S.C.

Led QA checks on Medicaid Eligibility, ensuring accuracy and compliance.

Streamlined processes using CURAM and OnBase, enhancing efficiency.

Collaborated with ESWs to address eligibility issues, improving resolution rates.

Analyzed data from MEDS/MMIS for quality improvements, driving better outcomes.

Executed thorough QA checks on Medicaid eligibility, ensuring compliance and improving accuracy in case assessments.

Maintained comprehensive documentation of eligibility checks, contributing to consistent audit readiness and regulatory compliance.

Actively supported team dynamics by encouraging open communication and collaboration, leading to improved team performance.

Utilized data analytics to identify trends in eligibility errors, implementing targeted solutions that led to noticeable improvements in case resolution.

Fostered cross-team partnerships with ESWs to tackle eligibility challenges, enhancing overall resolution efficiency.

Maintained meticulous records of QA checks, ensuring thorough documentation that supports consistent compliance and quality assurance.

ELIGIBILITY SPECIALISTSep 2023 - Apr 2024

TEKsystems/SCDHHSFlorence, S.C.

Efficiently process MAGI applications using OnBase and MEDS, ensuring accuracy and compliance.

Document accounts and conduct necessary applicant outreach, improving communication efficiency.

Utilize Excel and Microsoft Teams for data management, enhancing team collaboration.

Resolve application issues promptly, ensuring timely processing and applicant satisfaction.

Utilized Excel spreadsheets to analyze application trends, identifying areas for process improvement and contributing to overall operational efficiency.

ELIGIBILITY SPECIALIST IIAug 2022 - Feb 2023

AppleOne/SCDHHSFlorence, S.C.

Processed Medicaid MAGI applications using OnBase and other tools, ensuring timely approvals.

Documented account details and proactively contacted applicants, enhancing communication.

Utilized Excel and Microsoft Teams to streamline application processing, boosting efficiency.

Resolved application issues, improving accuracy and reducing processing time.

Collaborated with team to optimize workflows, achieving measurable improvements in service delivery.

Processed Medicaid MAGI applications with precision, ensuring compliance and reducing application processing time, enhancing overall service delivery.

Utilized OnBase and Excel to track application status, identifying bottlenecks that led to improved workflow and timely approvals.

Maintained thorough documentation of accounts and interactions, ensuring accurate records and facilitating seamless communication with applicants.

CUSTOMER SERVICE ADVOCATE IINov 2021 - Jul 2022

BCBSSCFlorence, S.C.

Processed veteran claims, enhancing accuracy and efficiency.

Handled provider inquiries, improving response times.

Communicated with providers, resolving claim issues effectively.

Engaged with providers via phone and correspondence, fostering strong relationships and improving communication effectiveness.

Analyzed claim discrepancies, implementing corrective measures that reduced processing errors and led to noticeable gains in accuracy.

Maintained comprehensive logs of provider interactions, ensuring compliance with regulatory standards and supporting efficient follow-ups.

Provided empathetic assistance to providers, enhancing their experience and reinforcing a culture of service excellence within the team.

CLAIMS, CUSTOMER SERVICE REPRESENTATIVE2016 - Dec 2019

Kelly Services/BCBSSCFlorence, S.C.

Processed claims, enhancing efficiency and accuracy in adjudication.

Resolved customer inquiries, improving satisfaction and retention.

Managed currency exchanges and employee support at Belk.

Assisted in customer service, ensuring smooth operations during peak times.

Handled inbound calls for AT&T, maintaining high service standards.

Processed and adjudicated claims efficiently, enhancing service speed and improving provider satisfaction.

Assisted customers in the Customer Service Area, fostering a positive experience and strengthening client relationships.

Handled inbound calls for AT&T, resolving issues promptly and contributing to a noticeable reduction in call wait times.

Coordinated with team members to cover shifts and ensure seamless service delivery, promoting teamwork and reliability.

Maintained accurate records of customer interactions, supporting compliance and enhancing operational efficiency.

Resolved customer inquiries effectively, contributing to a marked increase in satisfaction and strengthening client relationships.

CUSTOMER SERVICE DESK ASSOCIATE2009 - 2016

BelkFlorence, S.C.

Managed cash room operations, ensuring smooth currency exchanges and staff coverage.

Enhanced customer satisfaction through efficient purchase assistance and gift wrapping.

Developed strong multitasking skills by covering staff breaks and call-outs.

Resolved customer inquiries effectively, contributing to a positive shopping experience.

Provided exceptional customer assistance, enhancing satisfaction levels and fostering repeat business through positive interactions.

Streamlined cash room operations, improving transaction efficiency and reducing wait times for customers during peak hours.

Coordinated with team members to ensure seamless coverage during busy periods, maintaining service quality and operational flow.

Monitored inventory levels and customer preferences, enabling timely restocking and tailored promotions for increased sales.

Executed precise cash handling procedures, ensuring accuracy in financial transactions and compliance with company policies.

EDUCATION

DOCTORATE IN PUBLIC ADMINISTRATIONMay 2025

Liberty UniversityLynchburg Va

Beginning May 12, 2025

MASTER'S DEGREE IN PUBLIC ADMINISTRATIONJun 2024

Strayer University-Washington DC

Graduated Honors With Distinction GPA 3.916

BACHELOR'S DEGREE IN BUSINESS ADMINISTRATIONDec 2020

Strayer University

ASSOCIATE DEGREE IN BUSINESS ADMINISTRATIONDec 2019

Strayer University

COURSES

HOW TO PREPARE IMMIGRATION FORMS CERTIFICATEFeb 2025

NNA

SKILLS

OnBase, CURAM, MMIS, MEDS, Microsoft Teams, Excel, Leadership, Communication, Adaptability, Teamwork, Problem Solving, Critical Thinking, Customer Service, Claims Processing, Quality Assurance.

ADDITIONAL INFORMATION

PROFESSIONAL LICENSES

SCDLL&R Immigration Assistance Services Professional License (Mar 2025 - Jun 2026)

S.C. Notary Public (2020-Present)

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