Customer Service Representative

Lea Goldsmith

**** ********* ***** ***** ****** George, VA 23860

Phone: 804-***-**** Email: ************@*****.*** Customer Service & Healthcare Support Specialist

Objective

To leverage over 20 years of customer service expertise, including 5+ years in Medicaid and Medicare programs, to provide compassionate, accurate, and efficient support to clients while contributing to organizational excellence and compliance. Seeking a role that allows me to utilize my strong problem-solving skills, healthcare knowledge, and mentoring abilities to improve customer satisfaction and streamline case management.

Professional Summary

Seasoned and highly motivated Customer Service Representative with two decades of proven success in delivering exceptional support across diverse industries. For the past five years, I have specialized in Medicaid and Medicare eligibility and appeals, guiding individuals through complex healthcare processes with clarity and empathy. I am skilled in claims appeals, case management, and compliance with federal and state regulations, and I bring extensive knowledge of HIPAA requirements, database systems, and documentation standards.

I am recognized by colleagues and supervisors for my ability to de-escalate difficult situations, improve customer satisfaction scores, and mentor peers during high-pressure enrollment seasons. My background also includes customer-facing roles in the airline industry, where I supported VIPs, government officials, and international travelers, as well as leadership experience in community-based program management. This diverse career path has sharpened my adaptability, communication skills, and organizational abilities, enabling me to provide both frontline support and behind-the-scenes operational improvements.

Core Skills

• Medicaid & Medicare Eligibility and Appeals

• Customer Care & Conflict Resolution

• Claims Processing & Case Management

• Data Entry & Documentation Accuracy

• HIPAA & Compliance Regulations

• Process Improvement & Special Projects

• Microsoft Office & Database Systems

• Mentorship & Team Collaboration

Professional Experience

Customer Service Representative

TDB Communications Inc – Chester, VA Dec 2022 – Present

• Assist customers with claim denials and guide them through the Medicare appeals process.

• Manage high-volume inbound calls, addressing complex inquiries with empathy and accuracy.

• Maintain detailed customer records, ensuring accuracy of updates and case changes.

• Volunteer mentor during open enrollment, supporting training and team performance. Senior Eligibility Specialist

Cover VA – Richmond, VA Aug 2021 – Aug 2022

• Determined Medicaid eligibility in alignment with state and federal requirements.

• Reviewed and audited applications, ensuring accuracy and compliance.

• Verified physician and client documentation to finalize benefit determinations.

• Maintained electronic patient files with precision and confidentiality. Customer Service Representative

American Airlines – Richmond, VA Apr 2015 – Dec 2019

• Delivered frontline service, assisting passengers with travel arrangements, documentation, and security processes.

• Handled high-profile cases involving VIPs, dignitaries, and government officials.

• Oversaw ticketing, boarding, and baggage operations with efficiency and professionalism. Director

A World of Christian – Colonial Heights, VA Jan 2018 – Mar 2020

• Directed community program operations and special projects.

• Built partnerships with corporations, foundations, and sponsors to fund initiatives.

• Developed operational procedures to ensure compliance and program effectiveness. Education

High School Diploma – Bay Shore High School, Bay Shore, NY (1996) Certifications

Dual Certification in Marketplace Medicare – Apr 2023

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