Customer Service Representative (Healthcare & Insurance)
Resume:
OCTAVIA CHARLES
Beaumont, Texas ********@*****.*** 409-***-****
CUSTOMER SERVICE REPRESENTATIVE
PROFESSIONAL SUMMARY
Customer service professional with 8+ years of experience supporting customers and 5+ years of experience in healthcare and insurance-related environments. Experienced in high-volume call center operations, remote customer support, patient care coordination, claims and authorization support, complaint resolution, documentation, and CRM systems. Known for active listening, empathy, problem-solving, and providing accurate information while maintaining productivity and quality standards. Strong ability to work independently in remote environments, protect confidential information, and build trust with customers during sensitive or stressful situations. CORE COMPETENCIES
Customer Service & Client Support Remote Call Center Operations Client Satisfaction High-Volume Calls Active Listening & Empathy Customer Complaint Resolution Problem Solving Conflict Resolution Claims Support Medicaid & Medicare Insurance Verification Patient Care Coordination Data Entry CRM Documentation Salesforce HIPAA Compliance Microsoft Office Multi-Line Phone Systems Technical Troubleshooting Quality Assurance Time Management 60–80 WPM
PROFESSIONAL EXPERIENCE
ResultsCX LLC — Remote — Customer Service Representative June 2024 – Present
• Provide professional, empathetic customer service by addressing inquiries, resolving concerns, and working toward positive customer outcomes.
• Manage a high volume of incoming calls and customer interactions while meeting established response-time, productivity, quality, and performance standards.
• Build rapport with customers through active listening, empathy, patience, and personalized communication.
• Investigate customer concerns, identify root causes, and provide appropriate solutions while following company policies and procedures.
• Maintain accurate records of customer interactions, account information, and resolutions within CRM systems.
• Provide clear and accurate information while demonstrating strong knowledge of products, services, and customer-support procedures.
• Assist customers with website navigation, technical troubleshooting, and online transactions.
• Communicate effectively with customers and internal departments to resolve issues and ensure timely follow-up.
• Handle sensitive customer information professionally while maintaining confidentiality and accuracy. BCBS — Remote — Patient Care Coordinator September 2022 – June 2024
• Coordinated patient-care activities and supported communication between patients, healthcare providers, and internal departments.
• Provided compassionate customer service by addressing patient questions, resolving concerns, and helping create a positive experience.
• Maintained accurate patient records, insurance information, treatment information, and other confidential documentation.
• Assisted customers in understanding healthcare services, procedures, benefits, and available options using clear and professional communication.
• Facilitated communication between patients and healthcare providers to support efficient delivery of care.
• Performed data entry, billing coordination, insurance verification, and other administrative support functions.
• Protected confidential patient information and followed HIPAA requirements.
• Used organization and time-management skills to coordinate multiple patient needs and administrative responsibilities. BroadPath Healthcare — Remote — Healthcare Customer Service Representative June 2020 – December 2022
• Managed a high volume of customer calls while meeting established call-handling, productivity, and quality standards.
• Assisted patients and customers with billing questions, payment concerns, insurance coverage, and healthcare-related inquiries.
• Guided customers through healthcare enrollment processes and explained Medicare/Medicaid eligibility, benefits, and coverage information.
• Worked with insurance companies and healthcare providers to verify coverage and obtain pre-authorizations for medical procedures.
• Collaborated with claims-processing teams and other departments to help resolve customer and billing issues.
• Explained medical bills and healthcare charges clearly while assisting customers with payment-related questions.
• Demonstrated empathy and patience when assisting distressed customers and worked within established guidelines to resolve concerns.
• Coordinated appointments, referrals, authorizations, and other healthcare-related services.
• Maintained strict confidentiality of customer and patient information in accordance with HIPAA requirements.
• Helped reduce claim denials through accurate insurance verification and authorization processes. Taco Bell — Beaumont, TX — Restaurant Manager August 2020 – May 2023
• Managed daily operations while maintaining strong customer-service and quality standards.
• Supervised, trained, and coached employees to improve performance, productivity, teamwork, and customer service.
• Created employee schedules and coordinated staffing to support efficient daily operations.
• Resolved customer concerns professionally while maintaining a positive customer experience.
• Managed cash handling, deposits, inventory, labor costs, and daily operational procedures.
• Maintained accurate records and followed company policies, safety requirements, and operational standards. Popeyes — Beaumont, TX — Crew Member July 2018 – April 2020
• Provided friendly and efficient customer service in a high-volume environment.
• Processed customer transactions and handled cashier responsibilities accurately.
• Responded to customer requests and supported resolution of service concerns.
• Followed food safety, cleanliness, and company operating procedures.
• Worked effectively as part of a team while maintaining productivity during busy periods. Residence Inn by Marriott — Beaumont, TX — Housekeeping Attendant February 2018 – August 2019
• Supported guest satisfaction by providing consistent, detail-oriented service.
• Maintained guest rooms and common areas according to hotel quality standards.
• Organized supplies and completed laundry responsibilities efficiently.
• Demonstrated reliability, attention to detail, and professionalism in a hospitality environment. Alorica — Customer Service Representative May 2016 – August 2016
• Answered customer calls and provided professional assistance with service-related concerns.
• Accurately documented customer information and service requests.
• Submitted work orders and ensured information was entered correctly.
• Assisted customers with questions and worked toward timely issue resolution. TECHNOLOGY & CUSTOMER SERVICE SKILLS
Salesforce CRM Systems Microsoft Office Multi-Line Phone Systems Data Entry Online Customer Support Technical Troubleshooting Call Center Systems Typing: 60–80 WPM Quality Assurance Customer Documentation HEALTHCARE & INSURANCE KNOWLEDGE
Medicare Medicaid HIPAA Medical Terminology CPT Coding Insurance Verification Claims Support Prior Authorization Healthcare Benefits Patient Care Coordination HMO/PPO CoverMyMeds
EDUCATION
West Brook High School — Beaumont, Texas
High School Diploma
CERTIFICATIONS
Food Handler Certification Management Certification HIPAA Certification
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