Customer Care Representative (Insurance & Claims)

Elijah Oyeniyi

**** ***** ***** **, **********, Tx 77423 929-***-**** ******.*****@*****.***

Professional Summary

Customer Care Representative with 10+ years of contact and call center experience across insurance, banking, airline, healthcare and debt collection. Handles 60-80 inbound and outbound calls, emails and chats per day while meeting quality assurance, compliance and first call resolution targets. Experienced in claims and policy servicing, account maintenance, reservations and rebooking, patient scheduling, insurance verification and payment negotiation under HIPAA, FDCPA and bank privacy regulations. Recognized for de-escalation, accurate CRM documentation and consistently high customer satisfaction (CSAT) scores. Used Microsoft Office (Outlook, Excel, Word and Teams) alongside CRM software to manage customer correspondence, track open cases and share updates with internal teams.

Professional Experience

Customer Care Representative, Insurance

Texas Farm Bureau Insurance Remote Sept 2024 - Present

•Handle 70+ inbound calls daily from policyholders on auto, home and life insurance coverage, billing, premiums and claims status, maintaining a 95% customer satisfaction (CSAT) score.

•Process first notice of loss (FNOL) claims by gathering incident details, verifying policy coverage and routing files to claims adjusters within 24 hours.

•Explain policy terms, deductibles, endorsements and exclusions in plain language, reducing repeat calls and supporting a first call resolution (FCR) rate of 88%.

•Complete policy changes, renewals, reinstatements and cancellations accurately in the policy administration system and CRM software.

•Identified and resolved customer issues by troubleshooting billing, payment and account access problems and providing appropriate solutions on the first contact.

•Resolve billing disputes and premium payment issues, setting up payment plans and processing payments in line with PCI DSS requirements.

•De-escalate complaints from customers with denied or delayed claims and coordinate with underwriting and claims teams to reach resolution within 48 hours.

•Applied excellent verbal and written communication skills to explain policies, coverage and next steps clearly by phone, email and chat.

•Maintained up-to-date knowledge of company products, services, policies and procedures through ongoing training to provide accurate product and service information to customers.

•Identify coverage gaps during service calls and recommend additional products, contributing to a 12% increase in policy renewals and cross-sell referrals.

•Document every customer interaction in detail to meet state insurance regulations and internal quality assurance (QA) standards, scoring 96% on monthly call audits.

Patient Service Representative, Healthcare

Molina Remote Nov 2022 - Aug 2024

•Answered 75+ inbound calls daily from patients, providers and pharmacies regarding appointments, billing statements, referrals and test result follow-up.

•Scheduled, rescheduled and confirmed patient appointments in the Epic electronic health record (EHR) system, lowering the no-show rate by 15% through reminder calls.

•Verified insurance eligibility and benefits with Medicare, Medicaid and commercial payers before visits, and obtained prior authorizations when required.

•Explained copays, deductibles, explanation of benefits (EOB) statements and outstanding balances, and collected patient payments at the time of the call.

•Handled multiple tasks at once in a fast-paced call center environment, navigating several systems while speaking with customers and managing time effectively to meet handle time and quality targets.

•Protected patient health information (PHI) on every interaction by following HIPAA privacy rules and identity verification procedures, with zero compliance violations.

•Updated patient demographics, insurance information and call notes accurately, maintaining 98% data entry accuracy on quality audits.

•Routed urgent clinical concerns to nurses and physicians using triage protocols and escalated billing disputes to the medical billing team.

•Responded to distressed patients and family members with empathy and patience, earning a 96% patient satisfaction score.

Customer Service Representative, Banking

Stellar Bank Remote Jan 2019 - Oct 2022

•Assisted 80+ customers per day by phone, email and live chat with checking, savings, credit card and loan account inquiries, sustaining a 94% customer satisfaction (CSAT) rating.

•Verified customer identity on every contact using Know Your Customer (KYC) and authentication procedures to protect accounts and prevent fraud.

•Investigated and resolved transaction disputes, unauthorized charges and fee reversals, filing Regulation E claims and following cases through to closure.

•Detected and escalated suspicious account activity to the fraud prevention team, helping stop potential losses on flagged accounts.

•Followed up with customers by phone and email after escalations to confirm their issues were resolved satisfactorily.

•Processed account maintenance requests including address changes, card replacements, stop payments, wire transfers and online banking password resets.

•Guided customers through online and mobile banking enrollment, bill pay and Zelle setup, reducing repeat support calls.

•Referred customers to credit cards, personal loans and savings products based on their needs, exceeding monthly referral goals by 15%.

•Maintained compliance with bank policy, the Gramm-Leach-Bliley Act (GLBA) privacy rules and PCI DSS while keeping average handle time (AHT) under 6 minutes.

Customer Service Agent, Airline

Spirit Airlines Remote Mar 2017 - Nov 2018

•Managed 60+ daily passenger contacts for flight reservations, ticketing, seat assignments, baggage and schedule inquiries across phone, email and chat.

•Booked, changed and cancelled reservations in the Sabre global distribution system (GDS), building accurate passenger name records (PNRs) and applying fare rules correctly.

•Rebooked passengers affected by flight delays, cancellations and missed connections, securing alternative travel and reducing complaint escalations by 20%.

•Processed ticket exchanges, refunds, travel credits and ancillary fee payments in compliance with airline policy and PCI DSS standards.

•Opened and tracked delayed, damaged and lost baggage claims, updating passengers until each case closed.

•Contributed to continuous improvement by reporting recurring customer issues and trends to supervisors and suggesting service enhancements.

•Arranged special service requests for passengers with disabilities, unaccompanied minors and travelers with pets in line with Department of Transportation (DOT) rules.

•Calmed frustrated travelers during weather and operational disruptions through active listening and clear options, holding a 92% customer satisfaction (CSAT) score.

•Promoted loyalty program enrollment, seat upgrades and travel add-ons, exceeding ancillary revenue targets by 10% per quarter.

Collections Representative, Debt Collection

Midland Credit Management Remote Jul 2016 – Feb 2017

Made and received 100+ outbound and inbound calls per day through an auto dialer to recover past-due consumer accounts, meeting or exceeding monthly collection goals.

Negotiated payment arrangements, settlements and payment-in-full agreements based on each consumer's financial situation, recovering an average of $45,000 per month.

Complied with the Fair Debt Collection Practices Act (FDCPA), Regulation F, FCRA and TCPA on every call, including required disclosures and contact frequency limits.

Performed skip tracing using credit bureau reports and search tools to locate consumers and update phone numbers and addresses.

Verified right-party contact and account details before discussing debts, protecting consumer privacy and preventing third-party disclosure.

Processed credit card, debit card and ACH payments securely in line with PCI DSS standards and confirmed authorization on recorded calls.

Handled disputes, debt validation requests and cease-and-desist notices by documenting accounts and routing them to the compliance team within required timeframes.

Maintained a respectful, solution-focused tone with upset consumers, achieving a 95% quality assurance (QA) score and a promise-to-pay kept rate of 70%.

Education

High School Diploma

Saint Savior High School

Languages

English (Fluent)

Contact this candidate