Customer Service Care

Machee Hem

,, 305-***-****, *********@*****.***

SUMMARY

Dynamic Customer Care Specialist with over 15 years of experience excelling in customer relations and support. Proven track record of consistently achieving performance targets and proficient in addressing complex customer inquiries. Notable for resolving customer issues effectively while ensuring compliance with healthcare regulations. Adept at delivering tailored insurance solutions and building strong client relationships. leveraging exceptional communication and organizational skills to enhance client satisfaction and drive success in a remote environment.

WORK EXPERIENCE

06/2024 – 02/2025

Quality Assurance Specialist, Georgia State Affordable Health Plans

Georgia, USA

Ensured compliance with Georgia State Affordable Healthcare Act regulations for eligibility and enrollment.

Evaluated customer service representative calls for adherence to operational procedures and effective issue resolution.

Assessed call quality and performance based on comprehensive operating procedures.

Documented and communicated call feedback, while strategizing methods for issue triage to enhance improvement and consistency.

10/2023 – 03/2024

Customer Care Specialist, Broadpath Healthcare Solutions

Miami FL, USA

Handled inbound calls from healthcare customers, resolving a range of customer issues efficiently.

Consistently surpassed performance targets, demonstrating exceptional service delivery.

Advised clients on Medicare eligibility and benefits under Parts A, B, C, and D, presenting clear options.

Executed account benefit verifications requiring advanced decision-making skills based on payer systems and processes.

Managed reconciliation files from CMS, including disenrollments, late enrollment penalties, and low-income subsidies.

Processed monthly premium payments with accurate and timely execution.

02/2023 – 08/2023

Claims Specialist, Compsych

Miami FL, USA

Filed claims for family members efficiently, ensuring accuracy and adherence to guidelines.

Addressed queries regarding claim status promptly, facilitating clear communication.

06/2022 – 12/2022

Service and Sales Representative, Aptive Environmental

Miami FL, USA

Resolved customer issues effectively while achieving sales targets.

Delivered superior online retail customer service experiences.

02/2022 – 06/2022

Customer Support Advisor, Bank of West

Miami FL, USA

Provided comprehensive online banking support to inbound callers.

Delivered qualitative services, enhancing customer satisfaction.

Cultivated customer relationships and managed existing accounts effectively.

09/2021 – 02/2022

Health Connect Healthcare Advisor, State of Massachusetts

Massachusetts, USA

Managed patient inquiries and complaints, routing them to the appropriate medical staff.

Verified patients' insurance coverage and payment methods during admissions and check-in processes.

03/2021 – 09/2021

Insurance Customer Service Advisor, State of Maryland

Maryland, USA

Utilized systematic guides and interview techniques to extract necessary information from claimants.

Filed UI/PUA/PEUC claims for various claimants with accuracy.

11/2020 – 03/2021

Patient Access Specialist, Amerisource Bergen / Spectra Force Group

Miami FL, USA

Processed fees and claims submissions to insurance companies efficiently.

Communicated financial obligations clearly to patients, ensuring transparency.

09/2020 – 11/2020

Customer Service Advisor, State of Oklahoma

Oklahoma, USA

Guided claimants through the application process and made necessary adjustments to benefit claims.

07/2020 – 08/2020

Customer Service Advisor, State of Florida

Florida, USA

Provided guidance to claimants and facilitated their applications while adjusting benefit claims.

01/2020 – 03/2020

Customer Care Specialist (Seasonal), Jackson Hewitt Tax Services

Miami FL, USA

Addressed client requests by managing incoming calls and web chats efficiently.

Resolved first-tier level interactions through phone and chat support.

08/2019 – 11/2019

Customer Service Associate, WEX Inc

Miami FL, USA

Handled inbound calls from government and commercial vehicle fleet industry clients.

Resolved client issues promptly and effectively.

09/2016 – 03/2019

Sales and Service Specialist, Emerge BPO / Office Depot, Inc

Miami FL, USA

Delivered exemplary online retail customer service while ensuring order fulfillment.

Contributed effectively in high call volume environments.

EDUCATION

06/1990 – 05/1992

Annamalai University

MA, Business Administration

Chennai, India

SKILLS

Microsoft Office (Word, Excel, PowerPoint)

Customer Service

Order Fulfillment

Claims Processing

Sales

Communication Skills

Customer Handling

Phone Handling

Quality Compliance

Problem Solving

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