Senior Customer Service RepSenior Customer Service Rep

Key Achievements:

Directly supervise a high-performing team of 17 Quality Analysts across 5 distinct campaigns, driving operational standards, KPI achievement, and individual performance coaching. Prepare and present comprehensive performance reporting and data-driven quality insights during Weekly and Monthly Business Reviews (WBR/MBR) with client stakeholders. Report performance metrics, risk updates, and quality governance directly to Senior Quality Management up to Executive Leadership. Assisted in developing and testing AutoQA, our automated auditing tool, to simplify quality evaluations and improve client reporting.

Key Achievements:

Conducted comprehensive content and interaction audits to maintain strict adherence to quality standards and client moderation guidelines. Tracked quality trends, conducted root-cause analyses (RCAs), and presented actionable data insights during executive business reviews with operations management. Performed routine operational hygiene checks to enforce policy compliance, ensuring zero tolerance for Zero Tolerance Policy (ZTP) violations. Delivered regular "QA Talks" and calibration sessions to frontline agents, facilitating policy updates, Standard Operating Procedure (SOP) alignments, and operational best practices.

Key Achievements:

Evaluated user-generated online content with high accuracy and speed, applying SOP-specific tags and policy classifications in alignment with platform guidelines. Flagged and escalated critical policy violations, abusive content, and high-risk safety threats following strict emergency response workflows.

Key Achievements:

Earned promotion to Subject Matter Expert (SME) / Customer Service Lead within one year to handle complex escalated inquiries, claim appeals, and denied claim overturns. Assisted healthcare providers, members, and external health plan representatives (e.g., Humana, Anthem) regarding eligibility, benefits, prior authorizations, claims status, and coverage details. Executed targeted outbound calls to secondary health plans to verify eligibility and benefit details, proactively eliminating erroneous claim denials. Delivered real-time floor support, process coaching, and subject-matter guidance to customer service representatives to maintain team operational readiness. Managed core administrative tasks, including complex data entry, report generation, record maintenance, and operational documentation. Tracked key performance indicators (KPIs) and presented regular performance reports to leadership stakeholders. Partnered with cross-functional teams to identify operational bottlenecks, optimize ticket workflows, and improve core service tools.

Key Achievements:

Assisted healthcare providers, members, and external health plan representatives (e.g., Humana, Anthem) regarding eligibility, benefits, prior authorizations, claims status, and coverage details. Executed targeted outbound calls to secondary health plans to verify eligibility and benefit details, proactively eliminating erroneous claim denials.

Key Achievements:

Managed end-to-end processing and adjudication of specialized absence and leave insurance claims, including FMLA, Short-Term Disability (STD), Long-Term Disability (LTD), and Workers' Compensation.

Key Achievements:

Delivered customer support for retail accounts, managing order inquiries, cancellations, refunds, replacements, and billing adjustments. Specialized in the Account Change Department, managing complex account lockouts, identity verification, account compromise investigations, and security protocols.