Customer Service Associate

Education

Rochester institute of Technology September 1995

Graphic Design

Concentration: Free style painting and sculpting

Capstone: Work with individuals on art therapy type sessions. University of Rochester September 2001

Economics

Concentration: game theory

Capstone: Robotics Utilization University of Rochester clinical laboratory Experience

Centene Healthcare 04/15/2024-07/05/2024

Customer Service Associate Behavioral-Health

Help the member and provider with claims understanding and resolution. Educates the member with online resources and urgent risk situations.

Creating an emotional connection with our members by understanding and finding the solution for their need.

Performs review of member claim history to ensure accurate tracking of benefits and financial data maintenance as necessary.

Steven L. Trimble

5045 Berg Road Apartment A1 Buffalo, NY 14218

Phone: 585-***-****) E-Mail: (ad7ipz@r.postjobfree.com) S

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CVS Healthcare/Aetna 11/21/2022-08/31/2023

Customer Service Representative-Behavioral Health

Provides advocate care to assist the member with a clear path to care, claims understanding and resolution and educates the member with online resources. Creates an emotional connection with our members by understanding and engaging to the fullest to champion for their health.

Performs review of member claim history to ensure accurate tracking of benefits and financial data maintenance as necessary.

Eligibility updates submitted by clients internal and external vendors. United Health Group 11/28/2016-06/14/2022

United Healthcare Senior Appeals Representative 12/16/2021-06/14/2022: Researched and resolved written complaints submitted by consumers and physicians/providers. Rendered decisions for non-clinical complaints using sound, fact-based decision making. Completed necessary documentation of final appeals or grievance determination while communicating information via letter and/or written communication. United Healthcare Concierge Agent 11/28/2016-12/15/2021 : Best in class dedicated customer service agent which provided concierge and white-glove level service, removing burdens and providing end-to-end resolution for customers. This includes, but is not limited to: Clinical, Financial Decision Support, Behavioral Support, Claims inquiries, and more.

Provided a single point of contact for the customer. This gives customers the opportunity to form a relationship with their own Concierge.

Responded to and owned consumer inquiries and issues by identifying the topic and type of assistance the caller needs such as benefits, eligibility, claims, financial spending accounts, correspondence, pharmacy, Optum Behavioral Health and self-service options. Helped guide and educate customers about the fundamentals and benefits of consumer-driven health care topics to include managing their health and well-being by selecting the best benefit plan options, maximizing the value of their health plan benefits and choosing a quality care provider. Was the customer’s advocate and intervene with care providers (doctor’s offices) on behalf of the customer to assist with appointment scheduling, billing concerns, and coverage determinations. Assisted the customer with resolution as their advocate with 3rd party vendors. Assisted customers in navigating myuhc.com and other UnitedHealth Group websites or applications utilizing remote desktop system capabilities. Owned problem through to resolution on behalf of the customer in real time or through comprehensive and timely follow-up with the member. Communicated and kept consumer informed through the means in which they prefer, i.e. Phone Call, e-mail, etc…

Researched complex issues across multiple databases and work with support resources to resolve customer issues and/or partner with others to resolve escalated issues. Provided education and status on previously submitted pre-authorizations or pre-determination requests.

Met the performance goals established for the position in the areas of: conversation effectiveness, call quality, customer satisfaction, first call resolution, efficiency and attendance. Intervened with care on behalf of the customer to assist with appointment scheduling, and provider billing disputes.

Maximized use of community services, support programs, and resources available to member. Navigated through multiple platforms and databases to retrieve information regarding medical plans, prescription plans, flexible spending accounts, health reimbursement accounts, vision plans, dental plans, employer-based reward plans, claims submissions, clinical programs, etc. Assisted Tier 2/claims-DRW Inventory Management Commitment team on Acknowledgement calls and Resolution calls.

Assisted HealthSafe ID Technical Support-L1.5 Team with following issues:

•Account Locked/Unlocked

•Partial Account Locked/Unlocked

•Eligibility

•Forgot Username

•General HSID Questions and Navigation

•Password Reset/Forgot

•Registration

•Security Questions Reset/Unlock

•Swap Recovery Options

•Update Email address/Phone number

•Verify Email address and phone number

•All Application issues

•Known Issues with identified work around and/or workflow Floor Support:

o Provided side-by-side mentoring as needed

o Assisted the trainees with questions

o Reinforced the learning objectives

o Ensured trainees are following appropriate procedures o Demonstrated job function appropriate tools and techniques o reinforced Values and New Basic Principles

o Notified trainer, training manager, operations supervisor, etc. of trainee performance concerns as appropriate

Self Employed/Artist/Activist 06/10/2016-Present

Gallery Show Construction Date 03/01/2017. Benefit to help fund and bring awareness for domestic violence victims through activism in our community. Excellus Blue Cross Blue Shield 03/26/2007-06/09/2016 Senior Customer Satisfaction Advocate:

Supporting operational strategies and daily operations of the Call Center. Provided directions and guidance to Representatives. Monitored the volume and quality of work of employees. Dealt with customers through direct contact or through assisting staff in resolving customer inquiries via telephone, walk in, mail and email concerning, but not limited to, contract benefits, claim payments, and enrollment in accordance with MTM, Corporate Service strategy, NCQA and legislative requirements.

Demonstrated flexibility with scheduling to meet customer demands as a liaison among the customers, business partners, and Plans in a professional, self-directed manner to ensure and promote customer satisfaction and retention.

Essential Responsibilities/Accountabilities included promoting customer satisfaction and retention in all activities and functions. Accepted and actively promoted department, division and corporate initiatives.

Monitored employees and coaches to meet individual and department performance expectations. Informs management of department performance and employee issues. Monitored inquiries and identifies staff in need of improvement and retraining. Provided recommendations for staff improvement and retraining. Assisted with on-the-job training and recommends training and refreshers as needed. Worked with the trainer’s and conducted training sessions or meetings.

Assisted with managing work load for inventory control. Served as the unit expert regarding service issues for internal and external customers. Supported staff with escalated inquiries. Identified issues, patterns and/or trends generated by external and internal action effecting customer satisfaction and recommends solutions with options. Worked as systems/product expert in the training of trainers for all pharmacy products. Also co- trained six classes in accordance with also re-writing 200 pages of desk level procedures for the pharmacy help desk.

Traveled to different sites when training was needed. Completed Dale Carnegie public speaking certification.

American Red Cross 11/21/2003-03/01/2007

Clinical Technician:

Processed blood products in clinical laboratory setting for area hospitals in accordance with FDA standard operating procedures.€

Irradiation of products in a timely and efficient manner. University of Rochester Clinical laboratory 06/19/1993-11/01/2003 Clinical Technician:

Worked in a very technical setting that included centrifuging of blood products and processing them according to clinical needs.

Served as a trainer of new employees and current employees when new processes were involved. Senior representative in assisting other employees when needed with job functions. Worked independently on projects and also as a team member onsite and offsite. Worked with robotics in the processing of blood testing and specialty laboratory testing. Leadership

Safe Harbors of the Finger lakes 2016:

Worked in conjunction with staff of Safe Harbors of the Finger Lakes who provide services at no charge, for individuals, children, and families who have experienced sexual assault, sexual abuse, and interpersonal violence. Facilitating Art therapy sessions for clients that are co-facilitated with a professional therapist to encourage a creative outlet for expression. Designed a gallery show for national sexual assault awareness month with works from clients on display and all proceeds from sales going back to the artist/client. Making contact with community business leaders and other entities within the community willing to help in bringing awareness of this cause.

Skills & Interests

Skills: American Bankers Association Certified 2017-2022, Unet, Iset, Microsoft Outlook, One Note, Facets, Med Access, Lotus Notes, Sirs/Acs system, Microsoft Word, Excel, PowerPoint, Cognos, Tecan, Tigress, Microsoft teams. Systems, Medicare, Medicaid, Large and Small Group exchange commercial products, all lines of business for Pharmacy customer service, Dental customer service, Membership and billing. Activities: Art as Activism, Photography, Volunteering, Hiking and camping, enjoying all the cities around us and their urban beauty.

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