Detail-oriented, dedicated and energetic professional with 10+ years of successful experience. Committed in maintaining a reputation based on customer service, quality, and effective leadership. Currently seeking a position where I can effectively utilize my skills, abilities, and expertise as follows: * Team Lead/Oriented * Supervise/Mentoring * Medicare/Medicaid * Team building/Coaching * Operations Management * Strategic planning * Training and development * Grievance/Appeal Resolution * Child Welfare/Ambetter * Record/File Maintenance * Billing/Claims * Collection Analyst Chronology * Employment * Centene: Sunshine Health -Sunrise, FL - 2013 to Present Member Services Team Lead Bilingual - Creole & English Department of 15 Representatives Responded to over 50 calls per day which consisted of customer complaints/escalations, processed/reviewed Medicaid/Medicare documents, and analyzed patient records to verify eligibility. Functioned as leader making my team top performance in the company under the Member Services Manager, responsible for performing government agency filings, data entry, database maintenance, employee planning, and short-term projects. Top performer in providing assistance with credentialing and the primary source verification process for practitioners and health delivery organizations policy and procedures. Handled escalated calls within the department and provided exemplary customer service to customers, including members, vendors, providers, government agencies, business partners, * and the general public. Maintained grievance and appeal case files and other documentation to ensure compliance with state and federal regulations. Also maintain confidentiality and complied with HIPAA regulations. Received requests from doctors for prescription refills and processed with prior authorizations.

Highlights:

• Complaints
• Customer Service
• Negotiation Skills
• Retention
• Team Lead
• Call Center
• Microsoft
• Microsoft Access
• Microsoft Excel
• Microsoft Office