Appeals and Grievances Specialist-• Maintained business relationships with other departments to allow collaboration, ensuring all cases are closed within timely filing deadlines. • Created, maintained, and entered case information into the required systems using computer proficiency to complete cases efficiently and correctly. • Made outbound phone calls to obtain the necessary information to resolve the appeal or grievance assigned.• Provided required information to members or authorized representative.

- Promoted to a Team Leader position within 6 months of being a CSA III for achieving exemplary growth, exceeding the team goals. and continuing to improve on those goals each month with an upward trend.- Collaborated with managers, other team leads, various different departments and clients to meet customer service goals.- Completed daily and weekly coaching and up skill training to improve on required statistics such as After Call Work( ACW), Talk Time, Handle Time and Quality Assurance (QA).- Within 60 days of Team Lead promotion, the team was meeting all required metrics and were exceeding said goals by 90 days.

- Answered 15 to 20 phones calls per hour from members or providers and took messages as needed. - Used computer to retrieve policyholder information while maintaining proper phone and customer service etiquette.- Developed strong rapport with customers to de-escalate and resolve in-depth issues.- Established knowledge of protocols, answering customer inquiries, and reducing wait times by 7+ minutes.- Promoted from a CSA I, CSA II and CSA III within 9 months for exceeding goals and supporting company culture.

- Responsible for team of 25 customer service representatives.- Spearheaded team incentives and maintained interpersonal relationships to increase morale and team spirit.- Assessed and addressed needs related to the staff capability and staffing levels, focusing on current and anticipated demands.- Engaged in daily huddle with team to discuss and urgent or pertinent information that may have changed and to set the team most with a passive atmosphere.- Provided weekly direct and professional feedback to the Investigators relating to their case quality and productivity goals.- Monitored team’s performance, such as, call time, handle time, after call work, time management, and quality assurance.

- Oversee recruitment, hiring, and training of team members to further company goals and sustain high customer service benchmarks.- Used all available resources during the required 6-week program with zero loss and a 100% new hire completion rate.- Worked with management and clients to coordinate training materials used for new hire and up-skill training.