Patient-Cocused Customer Success Specialist

Rickia Evans

************@*****.*** Waxahachie, TX 75165

Professional Summary

Dedicated and empathetic Customer Success and Service Professional with over 10 years of experience driving client satisfaction, retention, and loyalty in fast-paced healthcare and service environments. Proven ability to manage complex customer interactions, resolve escalated issues, and deliver outstanding client experiences. Skilled in building strong relationships with customers, understanding their needs, and implementing solutions that improve operational efficiency and service quality. Adept at cross-functional collaboration, data entry accuracy, and ensuring compliance with organizational policies. Excels in inbound and outbound communication, patient support, and claims or authorization management. Committed to enhancing the customer journey through personalized care and proactive problem-solving to achieve measurable outcomes and business growth.

My Skills

Operational Skills: Customer Relationship Management, Prior Authorization Processing, Claims Management, Workflow Optimization, Quality Assurance, Data Entry, Process Improvement, Inbound and Outbound Communication, Problem Resolution, Conflict Management, Documentation Accuracy, Customer Retention, Patient Advocacy, Time Management, Scheduling Coordination, Multi-Tasking, Record Maintenance, Service Recovery, Policy Compliance, Service-Level Adherence

Technical Skills: CRM Systems (Salesforce, Zendesk), Med Compass, CEC, ASD, ATV, MS Office Suite (Excel, Word, Outlook), Electronic Health Records (EHR), Database Management, Call Center Software, Ticketing Systems, Reporting Tools, Knowledge Base Navigation, Telephony Systems, Email Management Tools, Data Analytics Basics, Workflow Automation Tools, Communication Platforms (Teams, Zoom, Slack), HIPAA Compliance Systems, Spreadsheet Data Entry, System Troubleshooting

Leadership & Communication Skills: Team Collaboration, Cross-Functional Communication, Customer Engagement, Empathy and Active Listening, Coaching and Mentoring, Written and Verbal Communication, Interpersonal Effectiveness, Negotiation, Conflict Resolution, Positive Attitude, Emotional Intelligence, Adaptability, Decision-Making, Leadership Support, Stakeholder Engagement, Time Coordination, Presentation Delivery, Call Center Management, Patience, Problem-Solving, Feedback Delivery

Key Achievements

●Recognized for maintaining a 98% accuracy rate in data entry and claim documentation.

●Successfully managed over 5,000 provider authorization requests annually with minimal escalation.

●Played a pivotal role in reducing average call handling time by 20% through workflow optimization.

●Awarded “Employee of the Month” for outstanding customer satisfaction and service delivery.

●Developed training reference materials for new associates, improving onboarding efficiency.

Professional Experience

Care Management Associate

Aetna Healthcare - Waxahachie, TX January 2020 – October 2025

●Assist care managers by collecting medical records, progress notes, and discharge summaries for care coordination.

●Conduct member outreach to ensure patients understand post-discharge instructions and available health plan resources.

●Update case management systems with accurate patient and provider information in compliance with HIPAA guidelines.

●Collaborate with clinical and non-clinical teams to support transitions of care and prevent hospital readmissions.

●Identify potential gaps in care and escalate complex cases to the appropriate nurse or case manager.

●Track patient outcomes and document follow-up actions to ensure continuity of care.

●Maintain high productivity and accuracy levels while managing multiple hospital caseloads.

Customer Success Specialist Aetna Healthcare

Aetna Healthcare - Waxahachie, TX January 2006 – December 2019

●Respond promptly to inbound and outbound provider and member inquiries, delivering consistent, high-quality customer support in alignment with company policies.

●Handle complex authorization requests, ensuring compliance with healthcare guidelines and timely approvals to enhance provider satisfaction.

●Collaborate with clinical teams to review prior authorizations, ensuring accurate data entry of diagnosis and procedure codes.

●Identify provider and member needs and refer them to specialized services for effective resolution and care management.

●Educate providers on authorization criteria and required documentation, improving accuracy and reducing follow-up calls.

●Utilize internal systems such as CEC, Med Compass, ASD, and ATV to process and monitor case progress efficiently.

●Achieved a 95% first-call resolution rate by implementing structured communication and issue-tracking methods.

●Improved provider satisfaction by 22% through enhanced responsiveness and education programs.

●Reduced prior authorization processing errors by 15% via meticulous data validation and cross-checking.

Education

High School Diploma – South Oak Cliff High School May 1996

Certifications

Life Insurance License

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