SHAUNTA K. SIMMONS
Silver Spring,MD
Summary
Experienced customer service professional with a background in the Healthcare industry. Seeking a challenging career with a progressive organization to effectively utilize my skills, abilities, and education in the customer service field. Known for knowledge and dedication, I excel in establishing rapport with clients and maintaining customer satisfaction. Specializing in quality, speed, and process optimization, I am articulate, energetic, and results-oriented. Exemplary in developing relationships, cultivating partnerships, and growing businesses.
Overview
10
10
years of professional experience
Work History
Provider Services Representative
The Jacobson Group
10.2023 - 05.2024
- Streamlined operations by managing a high volume of incoming calls (between 80-100 per day) for medical providers seeking information or assistance.
- Coordinated with internal departments on behalf of providers to ensure timely payment resolution for claims disputes or other financial matters.
- Enhanced customer satisfaction by efficiently resolving provider inquiries and concerns.
- Acted as a liaison between providers and company leadership, effectively communicating concerns and feedback to facilitate continuous improvement initiatives.
- Improved communication between providers and insurance companies, leading to better understanding of policy coverage and claim status.
- Implemented innovative tools within call center environment which boosted overall productivity of provider services team while maintaining high level of customer satisfaction.
- Maintained up-to-date knowledge on company products, services, and industry trends to provide accurate information to providers.
Customer Service Representative
The Jacobson Group Insurance Staffing
11.2021 - 09.2023
- Enhanced customer satisfaction by promptly addressing concerns and providing accurate information.
- Maintained detailed records of customer interactions, ensuring proper follow-up and resolution of issues.
- Collaborated with team members to develop best practices for consistent customer service delivery.
- Handled escalated high volume calls efficiently
- Managed approximately 80-100 incoming calls
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
Customer Service Representative
Cornerstone Staffing, Inc. Temporary Contract Position
08.2021 - 11.2021
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike. Call volume between 80-100
- Responded to customer requests for products, services, and company information.
- Inform customer of sales promotions and educate customers of online ordering capabilities and benefits of site
Customer Service Representative
Centene Inc.
02.2019 - 01.2021
- Maintained high levels of customer satisfaction and retention by first call resolution
- Logged call information and solutions provided into Omni database
- Troubleshoot issues such as medication, provider and general complaints
- Educated customers on product and service details and information
- Logged call information and solutions provided into Omni database
- Communicate with customers to access and address their individual needs, providing them with timely and quality support via EVS, Amisys, Portico, Trucare and ESI
- Achieved customer satisfaction rating of95% or better
- Resolved issues by coordinating with Claims, Authorization and Case Management teams
Customer Service Representative
Kaiser Permanente
12.2016 - 03.2018
- Customer service representative for the Mid-Atlantic States
- Assist members with excellent customer service and care
- Call center inbound calls between80-100 per day
- Respond to inquiries of existing members, prospective members, employment group representatives, brokers, providers regarding health benefits, plan options and services
- Assist members with benefit and eligibility inquiries
- Assist member with access to their online account using Kp.org, trouble shooting, and password reset
- Assist members and providers with claim and appeal information
- Assist members with compliments/complaints
- Assist members with monthly premium billing payments, balance due and refund inquiries
Full Service Rep Federal Enrollment
Care First Blue Cross Blue Shield
10.2014 - 05.2016
- Analyzed, processed, validated and providing assistance to all federal agencies
- Call center inbound and out bound calls between80-150 per day
- Assisted with enrollment, billing, claims adjudication interpretation of benefits and contracts
- Responsible for responding to telephone and written request from the Office of Personnel Management, federal agencies, other Blue Cross Blue Shield Plans and FEP members
- Educated the clients by supplying them with knowledge of company products through written telephone communication
- Responsible for providing service to federal employees through activation, renewal, cancellation and corrections to their federal enrollment contracts
- Achieved customer satisfaction rating100% by developing high level proficiency in providing both written and oral communication with internal/external customers/providers
- Obeyed HIPPA laws
- Handle high call values
MC311 Customer Service Representative
Montgomery County Government
02.2014 - 09.2014
- Receive incoming telephone calls from residents, providing assistance and processing non-emergency telephone calls
- Call center inbound calls between80-120 per day
- Listen to caller’s questions, ask relevant questions for clarification as necessary, evaluate information obtained, and provide the appropriate response through knowledge of County Departments and Agencies and knowledge-bases articles
- Perform data entry by creating specific service request for bulk trash pickup, replacement recycle bins, permitting and zoning inspections, and other county services
- Accurately entered data into system with minimal errors
- Data entry included obtaining and verifying personal information
- Utilized Microsoft Office Suite to type memorandum, receive and send emails, and create charts
- Refer residents to Agencies such as Department of Health and Human Services, Department of Permitting Services, Department of Finance, Department of Environmental Protection, and MANNA
- Assist Montgomery County Residents using public transportation services (i.e
- Ride-On, WMATA, Call-in-Ride, etc.) with trip planning, commendations, complaints
- Promptly refers emergency calls to911 emergency services as required
Education
Diploma -
Theodore Roosevelt Senior High School
Washington, DC06.1999
Skills
- Typing speed40 wpm, Microsoft Office Suite, Excel
- HIPAA compliance
- Claims processing
- Call center experience
- Healthcare industry
- Customer service
- Organizational skills
- Verbal and written communication
- Data entry
- Active listening
- Microsoft outlook
- Product knowledge
Timeline
Provider Services Representative
The Jacobson Group
10.2023 - 05.2024
Customer Service Representative
The Jacobson Group Insurance Staffing
11.2021 - 09.2023
Customer Service Representative
Cornerstone Staffing, Inc. Temporary Contract Position
08.2021 - 11.2021
Customer Service Representative
Centene Inc.
02.2019 - 01.2021
Customer Service Representative
Kaiser Permanente
12.2016 - 03.2018
Full Service Rep Federal Enrollment
Care First Blue Cross Blue Shield
10.2014 - 05.2016
MC311 Customer Service Representative
Montgomery County Government
02.2014 - 09.2014
Diploma -
Theodore Roosevelt Senior High School
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