Customer Service Supervisor

Christina Gower

**** ***** *****, ********, ** **428

214-***-****, *********************@*****.***

PROFESSIONAL SUMMARY

Dynamic and accomplished customer service supervisor with a proven track record in Health and Wellness Program referrals, claims processing, and consistently surpassing performance metrics. As a compassionate and knowledgeable Transgender Specialist, I bring a unique blend of empathy and expertise to my role. A motivated leader with exceptional organizational and prioritization skills, I excel in Customer Relations, Time Management, and First Problem Resolution. Proficient in PRIME/UNET systems and complex claims processing, I currently thrive as a Senior Premier Supervisor, driving excellence and innovation in every task. I would be an excellent addition to any service-related team.

EXPERIENCE

Premier Customer Service Supervisor September 2024- Present

Recruited and developed a specialized team, significantly reducing member abrasion and enhancing productivity.

Designed and implemented comprehensive training programs for staff, enabling them to handle diverse campaign types and dual call systems.

Monitored multiple SharePoint sites, collaborating with lead operations directors to ensure Employer Group satisfaction across various Premier Sites.

Established the Premier Advocacy Committee, "Team Magic," to disseminate learning resources widely and promote the Premier Model.

Led site and department meetings to enhance skills, provide tools, and monitor and improve performance.

Developed staff through coaching, performance feedback, effective assessments, and performance development plans.

Set priorities for the team to ensure task completion and achievement of performance goals.

Managed all human resources functions, including employee training, succession planning, performance evaluation, personal development planning, monthly coaching sessions, payroll management, conflict resolution, disciplinary actions, and team motivation to optimize individual and collective performance, build morale, and reduce turnover.

Oversaw the annual performance review process, including writing and delivering performance and compensation messages.

Monitored departmental productivity, reported on trends, and recommended and implemented changes to continuously improve work efficiency.

Tier 1 A4ME Customer Service Supervisor February 2022-September 2024

Develops staff through coaching, performance feedback, effective assessments, and performance development plans.

Sets priorities for the team to ensure task completion and achievement of performance goals.

Oversees all human resources functions, including employee training, succession planning, performance evaluation, personal development planning, monthly coaching sessions, payroll management, conflict resolution, disciplinary actions, and team motivation to optimize individual and collective performance, build morale, and reduce turnover. Keeps all employees informed through meetings and written communication.

Manages the annual performance review process, including writing and delivering performance and compensation messages.

Monitors departmental productivity, reports on trends, and recommends and implements changes to continuously improve work efficiency.

United Healthcare Premier Model Elite Super Advocate/ Transgender Specialist July 2020-February 2022

1311 President George Bush Hwy, Richardson, TX 75080

Team Lead, Roche Health Advocate Team, UHC Commercial Division: Lead an elite group dedicated to supporting and advocating for Roche employees through concierge service.

United Culture Ambassador.

Resolve escalated complex issues for high-touch members, collaborating with Client-Roche and internal partners on claim reconsiderations, clinical services, notifications, and appeals.

Provide proactive support for members with chronic issues, acting as their primary contact.

Attend escalation meetings with clients to remove obstacles and educate on resolution practices.

Lead training and onboarding for Elite Super Advocates.

Utilize Qfiniti and Nexidia for call auditing and scoring, coaching agents on missed opportunities.

Proficient in Microsoft Excel, Microsoft Office, 10-key, PRIME, UNET, ELGS, CAMS, IDRS, DATAMARK, DOC 360, LINX, Genesys, and Personal Health Messaging Center systems.

Use ICUE for HEDIS reminders, wellness resources, gap exceptions, and pre-determinations.

Perform call calibration, providing tips, job aids, and mock calls to improve metrics.

United Experience Champion: Manage inbound survey results, translating feedback into coaching opportunities.

Track team metrics (AHT, hold time, adherence, quality, transfer rate, callback rate, ACW, UACW, referral rate).

Answer advocate questions, assist with resolution strategies, and provide coaching.

Collaborate with supervisors on performance enhancement and communicate process changes.

Handle complex adjustments and overpayment processing, working with appeals, RX, claim reconsideration, and clinical review teams.

Premier Model Elite Superadvocate/Transgender Specialist Duties:

Educate LGBTQ+ members on plan benefits, gender affirmation services, and common medications (HIV/PrEP). Screen and identify culturally competent providers nationwide. Coordinate care with physicians for affirmation surgery timelines. Submit and monitor authorization requests. Process and reconsider claims. Advocate for additional plan coverage or case-by-case exceptions using clinical components and WPATH guidelines.

Facilitate Single Case Agreements and appeals for medical claims processing and preservice determinations.

Utilize and review The UniHub for Roche Genentech to monitor internal authorizations and ensure effective provider and member communication.

Provide direct intervention for pharmacy issues, particularly hormone therapy, by ensuring authorization criteria are met and expediting service approvals.

Collaborate with Included Health, a Roche partner, to offer seamless medical and mental health support for LGBTQ+ employees and dependents.

Ensure high-level support and advocacy for this micro population to promote healthier and happier lives.

A4me Simple claims adjuster – National Tier 2 advocate March 2018- July 2020

Performs all duties of the previous role for A4me Benefit advocate while processing simple and complex claims adjustments in real time.

Assessing the validity of claims submitted by medical providers to ensure they meet the terms and conditions of the insurance policy.

Gathering and reviewing medical reimbursement policies, logic the accuracy and completeness of the claim.

Communicating with Stakeholders: Interacting with healthcare providers, policyholders, and other parties to obtain necessary information and clarify details about the claim.

Authorizing/issuing payments to healthcare providers or policyholders based adjudication of the medical claim

Addressing any disputes or appeals from policyholders regarding denied or reduced claims and mediating between policy holder and provider billing.

Ensuring that all claims are processed in accordance with legal and regulatory requirements.

A4me Tier 1 Benefit advocate – Prime RV-NHP October 2016-February 2022

Handle call related to medical, mental health, dental, vision benefits.

Triage claims reconsiderations needs to connect with senior analyst for real time resolution

Help guide and educate customers about the fundamentals and benefits of consumer-driven health care topics to select the best benefit plan options, maximize the value of their health plan benefits and choose a quality care provider

Contact care providers (doctor’s offices) on behalf of the customer to assist with appointment scheduling or connections with internal specialists for assistance

Assist customers in navigating UnitedHealth Group websites, encouraging and reassuring them to become self-sufficient in using our tools.

Act as a Subject Matter Expert or mentor to other team members

Outbound Calls (Clinical/Welcome depending on team)

Contact this candidate