About

Seeking a role within an esteemed organization that appreciates dedicated team members, representing the company professionally, efficiently, and effectively. I am eager to leverage my extensive knowledge, skill set, and experience acquired in the medical/ health insurance-based profession. My strong suit includes exceptional communication skills, astute independent decision-making, and the ability to multi-task effectively. I excel at interacting with the public and prioritizing customer service.

Skills

  • Customer Service & Member Support
    10
  • Healthcare & Insurance Knowledge
    10

Experience

Ebony Thornton

Work experience
  • Responsible for ensuring that appropriate member treatment plans are followed on moderately complex cases and for proactively identifying ways to improve the health of our members and meet quality goals. Assesses member compliance with medical treatment plans. Identifies barriers to plan compliance and coordinates resolutions. Identifies opportunities that impact quality goals and recommends process improvements. Recommends treatment plan modifications and determines need for additional services, in conjunction with case management and provider. Coordinates identification of and referral to local, state or federally funded programs. Establishes and maintains relationships with agencies identified in appropriate contract.
  • Outreach Specialist – November 2020- April 2022
  • Care Guide I am assisting newly enrolled Medicare member with plan details, ensuring they are in the best plan suited for the maxim benefits, assessing LEP's and payment information. Supports member access to care through home visits, processing of reports, and distribution of collateral materials. Performs new member orientations. Provides superior quality outcomes by taking ownership of issues to ensure timely resolution or follow-up. Provides superior, professional, and courteous service to customers. Comprehends the various cultural and linguistic needs of the Medicaid and SCHIP population, knowledge of the various health and social services available in the assigned region with a special emphasis on services offered by community-based organizations, ability to work professionally with the company's associates, community-based organizations, providers and plan members.
  • CSR - November 2017 to November 2020
  • Multitasking between dual monitors while successfully answering Medicaid members benefit questions. Researching authorization information and transferring to the correct departments. Using multiple systems to locate and provide information on sent and received members pertaining to the members/providers. In Nov. 2018 I transitioned to the pharmacy dept. where I researched rejected claims and explained benefit information. Also, I was able to put in overrides, updating member eligibility, and authorization requests.
  • While serving as a Subject Matter Expert, I have successfully demonstrated my ability to not only assist as floor support with new hires and pharmacy reps, but also assisting more tenured agents with information and questions. I've also shown my willingness to help by providing assistance with locating information in MACESS, Atlas/KM or Compass when there is difficulty in locating resources.
  • Upskilled in claims training assisting our members and providers with claims issue and utilizing multiple systems.
  • I was a part of the NY Support Program in which I assisted the Quality Analyst department as an interim QA. When in the position I have gained training and knowledge on how to accurately audit calls, provide feedback, and coach my fellow peers according to the Anthem standard and C.A.R.E. call model.
  • Completing side by sides and providing immediate feedback as well as follow up feedback in writing.
  • Schedule and preform one on one coaching sessions with associates.

Ebony Thornton

Work experience
  • Multi-task all aspects of customer service for a busy auto repair shop, including educating the public about services, costs and warranties; invoicing and filing of receipts and document; and accounting for professional services rendered to auto repair clients. Answer phones and assist with up-sale of business.

Ebony Thornton

Work experience
  • Assist clients with in home care, provide ADL care, and transport clients. Dependable, flexible, independent management of responsibilities, team work, compassion, empathy.

Ebony Thornton

Work experience
  • December, 2011 - November, 2012
  • Fulltime
  • Managed medical office, answering the phone, triaging requests, customer service, scheduling appointments with doctors, assist clients with bathing and feeding, house cleaning and food preparation.