Experience

The Fulham Group

• United States
• Manufacturing
• 1 - 100 Employee

• Customer Care Manager

  • Feb 2022 - Present



Tufts Health Plan

• United States
• Insurance
• 700 & Above Employee

• Supervisor, Senior Products Member Services

  • Jun 2018 - Feb 2022

  • Coach, train, and monitor team of 20-28 representatives to deliver high standard of customer service while maintaining Service Level Agreements.• Resolve difficult member and employee inquiries by working collaboratively with other departments.• Analyze statistics to ensure all representatives meet or exceed department standards.• Review calls with employees regularly to help achieve more successful customer service interactions.• Develop, implement, and update best practices to streamline operations, standardize processes, and enhance customer service experience.• Oversee hiring and training of staff to further company goals and sustain high productivity.• Assist with high-level projects, such as scheduling, audits, real estate requests, and system testing.

• Team Lead, Senior Products Member Services

  • Mar 2017 - Jun 2018

  • Provided accurate interpretation of benefits, claims processes, and eligibility to members, providers, and employees to build member loyalty and meet corporate goals. • Performed weekly coaching sessions to provide feedback to representatives.• Worked with management to improve productivity and develop department growth. • Created and reviewed workflows for SupportPoint, our department’s knowledge management system. • Addressed and resolved customer complaints empathetically and professionally.



Memorial Sloan Kettering Cancer Center

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Insurance Specialist

  • Aug 2016 - Feb 2017

  • Reprocessed denied Medicare/Medicaid claims, in addition to verifying patient insurance information. • Contacted insurance carriers regarding reimbursements and ensuring all information is accurate. • Updated patient accounts in accordance with federal regulations, including HIPAA provisions. • Submitted appeals to Medicare and Medicaid with all pertinent medical documentation. • Reprocessed denied Medicare/Medicaid claims, in addition to verifying patient insurance information. • Contacted insurance carriers regarding reimbursements and ensuring all information is accurate. • Updated patient accounts in accordance with federal regulations, including HIPAA provisions. • Submitted appeals to Medicare and Medicaid with all pertinent medical documentation.



Tufts Health Plan

• United States
• Insurance
• 700 & Above Employee

• Member Services Team Lead

  • Jan 2015 - Apr 2016

  • Provided accurate interpretation of benefits, claims processes, and eligibility to members, providers, and employees to build member loyalty and meet corporate goals. • Performed weekly coaching sessions to provide feedback to representatives.• Worked with management to improve productivity and develop department growth. • Created and reviewed workflows for SupportPoint, our department’s knowledge management system. • Addressed and resolved customer complaints empathetically and professionally.

• Member Services Representative

  • Jan 2014 - Jan 2015

  • Received and responded effectively to a high volume of incoming telephone calls• Accessed the most appropriate sources of information and proficiently resolved the members’ concerns• Provided orientation to members regarding plan benefits, eligibility, and enrollment policies and procedures• Consistently exceeded position standards for adherence, post-call processing, and quality• Winner of company-wide “Member’s Matter” idea competition in August 2014



Phantom Gourmet

• United States
• Entertainment Providers
• 1 - 100 Employee

• Assistant Manager of PGC Inc.

  • Sep 2011 - Dec 2013

  • Oversee the sales and daily operations of Phantom Gourmet restaurant gift cards• Manage and supervise multiple kiosks at various malls throughout New England• Perform personnel actions such as hiring employees and providing employee orientation• Create work schedules and organize employee time sheets• Assisting and leading sales with customers on a regular basis • Oversee the sales and daily operations of Phantom Gourmet restaurant gift cards• Manage and supervise multiple kiosks at various malls throughout New England• Perform personnel actions such as hiring employees and providing employee orientation• Create work schedules and organize employee time sheets• Assisting and leading sales with customers on a regular basis