Claims & Customer Service Specialist Medicaid Support

Vaesha Alston

919-***-**** ************@*****.***

Documented and tracked tickets using CRM systems like ticket closure within SLA.

Delivered clear explanations of complex plan designs for Medicaid plans.

Document all interactions in EMR/CRM systems with

standards.

Rocky Mount, Nc, 27804 Open to Relocate

:Relationship building & rapport, documentation accuracy, Data entry

:Claims Support & Eligibility Verification, Policy Explanation & Billing Inquiries Reduce broken promises by 15% through consistent follow-up and clear communication of expectations. Resolve 90% of customer disputes on the first call, reducing escalations and improving customer satisfaction. Increase successful payment arrangements by 28% after implementing improved negotiation and follow-up techniques.

Increase successful payment arrangements by 28% after implementing improved negotiation and follow-up techniques.

while maintaining HIPAA and privacy

:ServiceNow Zendesk Salesforce, JIRA Service Desk, Ticketing & Case Management

:Cross-Functional Collaboration, High-Volume Call Handling, SLA & KPI Compliance

, and ServiceNow, ensuring 100%

Detail-oriented and solutions-driven Claims & Customer Service Specialist with 7+ years of experience supporting members, resolving claim issues, and delivering exceptional service in fast-paced, high-volume environments. Skilled in researching and processing claim inquiries, explaining benefits, and troubleshooting coverage or billing discrepancies with accuracy and compassion. Proven ability to de-escalate concerns, exceed performance metrics, and provide clear, tailored resolutions across phone, chat, and email Conducted quarterly business reviews (QBRs), presenting ROI metrics and custom roadmaps to executive stakeholders, maintaining 97% satisfaction scores. Supervised and coached a team of customer support agents, improving team productivity by 25% through performance feedback and training..

Collaborated with QA and Training departments to update knowledge base content, decreasing ticket handling time by 20%.

Maintained a

channels.

Increased member engagement by 22% through proactive outreach, personalized education, and consistent follow- up.

Resolved 87% of member inquiries on the first contact, reducing escalations and boosting member satisfaction scores.

by delivering empathetic, patient-centered support across phone, email, and chat

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SKILLS

Productivity

Healthcare Systems

Customer Engagement

SUMMARY

EDUCATION

Technical Skills

WORK EXPERIENCE

1999-Rocky Mount Senior High-

Claims Processor, (Hunter Hill Assisted Living)

Call Center Collector, (Afni), Remote

Customer Support Team Lead, (Amazon)Remote

Customer Service, (Securitas), (Remote)

95%+quality score

100% accuracy

Zendesk, Salesforce

HMO, PPO, EPO, Medicare Advantage, and

Mar 2021 - April-2024

May 2024— Aug 2025

June 2023 — May 2024

July 2025— Present

Diploma

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