Member Experience & Claims Support Specialist
Resume:
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Houston, TX *****
*********@*****.***
SKILLS
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• Client Care service
• Accounts Receivable Management
• Call Volume and Quality Metrics
• Claim Denial Resolution
• Billing documentation
• Document and Records Management
• Proficient in CRM software and
ticketing system
• Aging reports analysis
• Empathetic and customer-focused
approach
• Insurance Follow-Up
• Data Entry
• Consumer Portal
• Epic System
• HIPAA Compliance
• Customer Escalations
• Strategic sales knowledge
• Service standard compliance
• Call Routing
• HIPAA Compliance
• Process Improvement
• Technical Support
• Payment Posting
• Customer Service
• Proactivity
• Adaptability
• Strategy Implementation
• Strategic Planning
• Project Implementation
• Cadence
• Debt Settlement
• Training & Onboarding
• Software as a Service
TECHNOLOGIES
• Avaya
• Ava
• SAP
• UKG
Member Experience Associate with a strong background in enrollment processing, administrative support, and customer service. Highly detail-oriented and empathetic professional skilled in handling high-volume inbound and outbound inquiries, resolving support tickets, and maintaining precise documentation. Proven track record of reducing claim denials, accelerating collections, and ensuring strict adherence to HIPAA and payer policies. Proficient in leveraging EHR systems such as Epic to resolve discrepancies, improve workflows, and shorten reimbursement cycles. WORK HISTORY
June 2025 – Present
Customer Support Specialist – Fresenius Health Remote
• Manage a high volume of inbound and outbound calls from qualified Medicare participants, assisting with enrollment, benefits investigations, billing, and claims while maintaining professionalism and prioritizing customer needs. Implement strategic planning for large accounts and assist in onboarding new clients.
• Manage a high-volume book of 300+ accounts, Facilitating smooth post- sales journeys from adoption to renewal.
• Analyze insurance EOBs to identify denial reasons, uncover billing discrepancies, and determine corrective follow-up actions to accelerate reimbursement.
• Resolved complex claim denials and recovered substantial revenue by improving claims resolution procedures.
• Collaborated with cross-functional teams to ensure insurance eligibility and compliance with HIPAA standards.
• Created onboarding guides and delivered training to new hires to standardize AR follow-up protocols.
• Accepted and processed customer payments and applied toward account balances.
• Notified credit departments and turned over records to attorneys when customers failed to respond to collection attempts.
• Maintained accurate records of customer interactions and insurance verification status in Epic.
• Streamlined communication with patients and payers to resolve issues efficiently and improve satisfaction.
• Participated in team planning sessions to enhance service delivery and reduce billing errors.
• Wrote appeal letters to insurance companies for denial of claims.
• Contacted insurance companies to check status of claim payments.
• Supervised and mitigated at-risk accounts by proactively analyzing the situation and addressing escalations, collaborating with internal teams, and implementing retention strategies.
• Exceed performance metrics consistently, earning recognition as a top performer within the team.
• Spoke with customers to learn reasons for overdue payments and to review terms of credit contract.
• Supported vendor, third-party logistics, and procurement operations by maintaining accurate contract and vendor records within Coupa and related systems.
MICHAEL OWOEYE
• Oracle
• Five9
• Onbase
• Excel
• Salesforce
• ServiceNow
• Genesys Cloud
• Talkdesk
• Zoho Desk
• Zendesk
• Google Suite
• Slack
• Zoom
• Microsoft Teams
• WebEx
AFFILIATION
• United Way, Volunteer.
• US Navy Spouse
• Managed end-to-end billing workflows from charge entry through claim submission, correction, rebilling, and follow-up across multiple payer portals and clearinghouses.
• Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
• Manage inbound and outbound customer calls/emails/chatbots, providing prompt and efficient resolution to customer inquiries on products.
• Maintained a high level of customer satisfaction (CSAT) by effectively handling customer-support inquiries across all communication channels, including product questions and production issues.
• Respond to customer requests for products, services, and company information.
• Utilize customer service software to manage interactions and track customer satisfaction.
December 2023 – May 2025
Customer Support Specialist– Alignment Health, Remote
• Respond to customer inquiries promptly and accurately using Salesforce CRM applications.
• Review all patient insurance information needed to complete the benefit verification process.
• Partnered with clinical, coding, and billing teams to correct charge errors, prevent downstream denials, and support compliant revenue capture.
• Maintain accurate records of customer interactions, ensuring seamless follow-up when needed.
• Conducted contract modeling and reimbursement validation across Medicare Parts A–D, Medicaid programs, and commercial plans to ensure accurate classification, billing, and payment.
• Served as a liaison between patients, providers, and insurance carriers to explain benefits, financial responsibility, and claim outcomes, ensuring transparency and timely issue resolution.
• Improved patient satisfaction and reduced repeat inquiries by proactively identifying account issues and educating members on coverage, billing timelines, and payment options.
May 2019 - December 2023
Customer Support Specialist– Optum Inc. Houston, TX
• Mastered contact center processes and procedures, expertly addressing customer inquiries and resolving issues efficiently.
• Partnered with cross-functional teams to swiftly resolve consumer inquiries and provide application support. Suggested functionality enhancements, boosting customer satisfaction by 10% and increasing product adoption.
• Accelerated reimbursement by optimizing insurance and personal payment posting processes.
• Manage new order intake with precision, reviewing and verifying all clinical, billing, and care-related documentation for accuracy and completeness.
• Negotiated payment plans and followed up on outstanding accounts, improving cash flow and patient experience.
• Increased claim acceptance by proactively monitoring statuses and correcting submissions.
• Performed denial management including appeal writing and insurance correspondence.
• Verified patient-specific benefits and precisely documents specifics for various payer plans such Medicare Advantage, Full Medical FSA
(Flexible spending account), HSA - Health Saving Account, including patient coverage, cost share, and access/provider options.
• Supported AR team with discrepancies and error resolution across billing systems.
• Reconcile and coordinate invoice correction requests received from all business segments with a high level of accuracy, prioritizing tasks according to established service level agreements (SLAs).
• Streamlined claims correction processes, ensuring timely resubmission and accurate posting of insurance and personal payments.
• Advised delinquent customers on strategies for debt repayment.
• Developed efficient workflows that reduced rework and billing cycle times.
• Partnered with cross-functional teams to swiftly resolve consumer inquiries and provide application support. Suggested functionality enhancements, boosting customer satisfaction by 10% and increasing product adoption.
• Adhere to company policies, PHI/PI guidelines, and applicable laws, escalating issues to clinical or technical teams as needed.
• Performed denial management including appeal writing and insurance correspondence.
• Delivered data-driven insights to the internal product development team, directly contributing to the successful launch of 14 product enhancements within one year.
June 2018 - April 2019
Customer Support Specialist– Financial Summit Disclosure. Houston Tx
• Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
• Researched credit balances and initiated refunds as required to maintain accurate financial records.
• Contacted customers with delinquent accounts to solicit payment.
• Completed month-end and year-end closings, kept records audit-ready and monitored timely recording of accounting transactions.
• Enhanced customer satisfaction by promptly addressing concerns and providing accurate information.
• Answered constant flow of customer calls with minimal wait times, showcasing adaptability and excellent time management skills.
• Met customer call guidelines for service levels, handle time and productivity, effectivity communicating service standards.
• Collaborated with staff members to enhance customer service experience and exceed team goals through effective client satisfaction rates.
• Developed highly empathetic client relationships and earned reputation for exceeding service standard goals.
EDUCATION
May 2018 - Bachelor of Business Administration and Management Texas Southern University, Houston, TX
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