Member Support & Care Coordination Specialist

PALACA KNIGHT

Covington, GA

678-***-**** ************@*****.***

PROFESSIONAL SUMMARY

Member-focused healthcare and customer support professional with 5+ years of experience delivering high-quality intake, triage coordination, and case management support in fast-paced, high-volume environments. Proven ability to serve as a first point of contact, educate members on benefits and resources, verify eligibility, and route cases accurately across multidisciplinary teams. Highly skilled in navigating multiple systems simultaneously, meeting productivity and quality metrics, and providing empathetic, concierge-level service that enhances the member experience.

CORE COMPETENCIES

• Telephonic Intake & Member Triage

• High-Volume Inbound & Outbound Calls

• Member Eligibility & Benefits Verification

• Case Assignment & Workflow Management

• Healthcare Navigation & Patient Advocacy

• Account Setup, Maintenance & Troubleshooting

• Cross-Functional Collaboration (Nursing, Scheduling, Tech)

• Documentation Accuracy & Compliance (HIPAA)

• CRM & Multi-System Navigation

• Time Management & Productivity Metrics

• Professional Communication & De-Escalation

PROFESSIONAL EXPERIENCE

U.S. Small Business Administration (SBA) — Disaster Recovery Specialist

Remote Full-Time Aug 2020 – Sept 2025

• Served as the first point of contact for individuals seeking assistance, delivering compassionate, high-quality support in a high-volume call environment

• Managed 80–100+ inbound calls per shift while meeting strict productivity, quality, and documentation metrics

• Conducted detailed intake assessments, verified eligibility, and routed cases to appropriate internal teams for resolution

• Maintained an active inventory of cases, ensuring timely follow-ups and accurate case status updates

• Educated clients on available benefits, next steps, and required documentation to improve outcomes and satisfaction

• Navigated multiple internal systems simultaneously to retrieve, update, and validate member data

• Collaborated closely with supervisors, technical support, and case review teams to resolve complex issues

• Maintained precise, audit-ready documentation to ensure compliance with federal regulations and internal policies

Healthcare Billing & Patient Support Experience

Medical Billing / Patient Services Various Roles

• Provided front-line support to patients and members regarding healthcare services, billing inquiries, and coverage questions

• Performed eligibility verification using payer and health plan databases

• Assisted with account setup, password resets, and demographic updates

• Routed patient concerns and clinical inquiries to appropriate nursing or specialist teams

• Ensured all documentation met HIPAA, quality, and compliance standards

• Supported care coordination efforts by communicating clearly with providers, care teams, and internal departments

TECHNOLOGY & SYSTEMS

• CRM & Case Management Systems

• EHR / Medical & Benefits Platforms

• Microsoft Office Suite (Word, Excel, Outlook)

• Multi-Line Phone & Call Center Systems

• Secure Databases & Member Portals

• Remote Work Tools & Secure Connectivity

SKILLS & QUALIFICATIONS

• High-volume call handling in fast-paced environments

• Exceptional verbal, written, and interpersonal communication

• Strong attention to detail and documentation accuracy

• Ability to prioritize multiple high-priority tasks with minimal supervision

• Professional, calm, and empathetic demeanor with members

• Strong critical thinking and problem-solving skills

• Fully equipped distraction-free home office with hard-wired high-speed internet

EDUCATION & CERTIFICATIONS

• Certified Medical Assistant (Preferred / Related Training)

• Ongoing professional development in healthcare operations and member services

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