Customer Service Call Center

Tiffany N. Horton

**** ****** *** ***** ****, FL 33566

313-***-**** *************@*****.***

EDUCATION

Capella University

Bachelor of Psychology December 2018

LICENSING/TRAINING/SYSTEMS

Health License 2-40 -Medicare

Microsoft Office tools namely Excel, Outlook, PowerPoint, One Note, Adobe Acrobat, and instructional design, including, release manuals, help files, and knowledge base articles.

SharePoint, NPS Survey, Quick Base, Five9, Avaya, Skype, Cisco, Canvas, Sales Force

Medical Terminology, ICD-10 knowledge, Documentation, HIPAA compliant

SKILLS

Ability to work well with people of diverse backgrounds and disciplines. Deadline-oriented, work well in stressful situations and environments.

Ability to think critically in the assessment of materials that will help the team understand new concepts and procedures.

Excellent conflict management, interpersonal, and customer service skills

Outstanding organization and administrative accountability

Ability to read, interpret, and create documents such as procedure manuals, and written correspondence.

Leadership skills, proven ability to motivate, inspire, and coach team members.

EXPERIENCE

MetLife, Tampa, FL, June 2022- present

Client Service Consultant

Overall accountability for the day-to-day administration of multiple or complex clients, including:

Responds to client requests and leads projects, provides clients with alternative solutions to requests and can identify possible plan design alternatives, and acts as a liaison between the client and internal MetLife teams.

Responsible for providing exceptional customer service through ongoing customer delivery and client satisfaction.

Coordinates and facilitates client meetings, in person or via conference call, and prepares materials, agendas, and presentations, leads client account audits and strategic planning process, and partners with the financial team in the completion of client reports.

Serves as a key resource and may serve as a subject matter expert to Customer Unit and Regional Market accounts.

Partners with Proposal Unit to research and respond to RFP questionnaires.

Understands the detailed components and provisions in legal agreements between MetLife and the client and assists in facilitating the execution of contracts to ensure compliance.

Comprehends competitors’ products, industry trends, and legal developments impacting business.

Firm knowledge of MetLife’s group products, services, and systems and ability to apply analytical skills to the interaction of these products, services, and systems.

Long-Term Care Coordinator, June 2017 – June 2022

Manages assigned caseload with limited supervision.

Identifies information needed to make benefit eligibility determinations with an overall decision of 97%.

Follows established policies and practices to resolve claim issues.

Responsible for quality check of claims processed in the claim system for processing and financial accuracy.

Reviews bills/invoices for evidence of fraud.

Reviews claim data to make claim settlement decisions.

Appropriately escalates issues to the supervisor for resolution a s needed.

Performs other related duties as assigned or required.

Review medical, legal, and miscellaneous invoices to determine if reasonable and related to the ongoing claim. Maintain documentation of all client encounters and completed reporting requirements according to organization standards.

Track client information, schedules, files, and forms in a confidential manner.

Conduct quality assurance and monitoring activities for service delivery and documentation.

Total Insurance Broker, Tampa, FL

Call Center Quality Internal Auditor, Sep 2019 – May 2022

Reviews quality of work and performance of Sales Agents & Customer Service Reps through live monitoring and use of call recording systems and applications.

Identifies training needs and communicates needs to the training department as needed.

Compiles Quality Assurance (QA) assessments of call center agents, and documents results within an established repository by defined departmental policies and procedures. Uses a quality monitoring system to compile and track performance at team and individual levels.

Engages in calibration sessions on calls for all products/programs with call center management.

Provides actionable data and feedback to call center managers and the leadership team.

Identify and recognize call center quality and performance trends and communicate to the leadership team.

Works with internal business units to increase awareness of the importance of compliance, FWA plans, and the Code of Conduct.

Maintains working knowledge of all applicable Centers for Medicare & Medicaid Services (CMS) regulatory guidance with the ability to interpret and communicate to others in layman’s terms.

Creates and maintains standardized workflows and procedures. Provides recommendations for change and participates in the analysis of workflows and procedures to improve accuracy/efficiency.

Prepares and analyzes internal and external quality reports for management staff review

Leadership and development

Humana Health Care, Tampa, FL

Licensed Insurance Agent, Jan 2008 - Jun 2017

Respond to customers' calls as well as their needs and then build a comprehensive solution.

Use sales and relationship-building skills as well as product expertise to guide the consumer in making an informed decision and benefits administration.

Extensive knowledge of Medicare Regulation.

Use the appropriate interpersonal style and communication methods to gain acceptance of a product, service, or idea from prospects.

Develops a base for long-term sources of clients. Ascertains clients' long-term goals.

Develops a coordinated protection plan by calculating and quoting rates for immediate coverage action and long-term strategy implementation.

Obtains underwriting approval by completing an application for coverage.

Updates job knowledge by participating in educational opportunities, maintaining personal networks, and participating in professional organizations.

Enhances insurance agency reputation by accepting ownership for accomplishing new and different requests and exploring opportunities to add value to job accomplishments.

Maintains working knowledge of all applicable Centers for Medicare & Medicaid Services (CMS) regulatory guidance with the ability to interpret and communicate to others in layman’s terms.

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