Customer Experience Specialist Ii

TUMU NEWELL

Customer Experience Specialist

***********@*****.*** +1-570-***-**** Canadensis, PA 18325

WORK EXPERIENCE

Customer Experience Specialist II

METLIFE GROUP

June 2022 - September 2024 Remote

Transformed customer interactions into exceptional experiences, supporting policyholders through education and strategic problem-solving initiatives.

Resolved customer inquiries via email, chat, and calls, achieving a one-touch resolution rate of 90%.

Built strong knowledge of services offered by continuously learning in order to assist in policy and claims details.

Acted as a liaison for internal departments such as claims, billing and sales by answering questions and escalating any possible issues for research or resolution.

Health Coordinator Assistant

ACCOLADE

January 2019 - February 2022 Scottsdale, AZ

Assisted members with making decisions about their healthcare needs by translating members benefit packages & care plans. Conducted provider searches and uncovered care need barriers. Identified appropriateness of care and connected member with the right clinical resource (ex. Clinician, Health Plan Disease Management, Health Plan Case Management).

Assisted with claims, pre-certification process by leveraging technology & internal resources available to help understand the member's path, actions needed & next steps.

Call Center Specialist II

MASSMUTUAL LLC

February 2017 - June 2018 Phoenix, AZ

Provided high quality, accurate and time-sensitive information and services to brokers.

Answered questions with an emphasis on guidelines, knowledge, problem solving, and adherence to policies and procedures. Processed disbursements, and other financial transactions. Policy Service Consultant

CAREER OBJECTIVE

Seeking a full-time, permanent,

Customer Care-based position within an

organization which will allow me to

utilize and expand upon my customer

service, problem-solving, and

administrative skills. Authorized to work

in the US for any employer

EDUCATION

GED

Cal State Fullerton

February 2005 - April 2005

Fullerton, CA

SKILLS

Medical Terminology

Microsoft Office

Microsoft Powerpoint

Microsoft Word

Insurance Verification

Financial Services

CRM Software

HIPAA

Microsoft Outlook

Technical Support

HIPAA

Empathy: Being able to understand

and relate to the emotions and

perspective of others

Adaptability: Being able to adjust to

different situations and needs

Conflict Resolution

Communication: Being able to clearly

convey information and listen actively

PROGRESSIVE CASUALTY INSURANCE COMPANY

October 2014 - August 2016 Phoenix, AZ

Responsibilities included assisting customers with insurance needs like adding/deleting vehicles and drivers from policies, or processing renewals, cancellations, reinstatements, and payments. Duties also included answering coverage and state guideline questions, explanation of rate and billing inquiries, performed policy reviews and responsible for influencing customers to obtain quotes to add additional coverages or policies such as homeowner, renters, etc.

Specialty Pharmacy Representative

UNITEDHEALTH GROUP

January 2011 - July 2014 Cypress, CA

Duties included answering incoming calls; assists

customers/pharmacies/physicians with orders andreorders, benefit eligibility questions and prescription status inquiries. Escalated drug related callsto appropriate pharmacist. Assisted pharmacies and members on all issues related to processingof pharmacy claims.

Determined appropriateness of overriding pharmacy claims edits and errormessages.

Coordinated internal resolution of claims exceptions and other issues.

Made outbound calls on prescriptions with hold orders and payment issues, also assisted with entering new prescription ordersinto system.

Educated customers on benefits, use of plan, formulary, premiums

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