Hallie Pike
Benton,AR
Summary
Dynamic customer service professional with extensive experience at centene, excelling in complaint handling and problem-solving. Proven track record of enhancing member satisfaction through effective communication and quality assurance. Skilled in CRM software and adept at maintaining composure under pressure, ensuring efficient resolution of inquiries and issues.
Overview
10
10
years of professional experience
Work History
Member and Provider Customer Service Rep I
Centene
09.2024 - Current
- Assisted customers with inquiries regarding healthcare services and benefits
- Resolved issues through effective communication and problem-solving techniques
- Inbound calls for Members & Providers
- Prior Authorization status
- Provider Appeal. claims status, Prior Authorization
- Assist with Material request
- Crossed trained for 2 different States
- Resolving issues
- Data Entry Read Claim status to members and providers
- Submit Grievances
- Make sure to listen to my graded calls every week
Member Service Customer Service Rep I
Health Care Solutions
10.2023 - 04.2024
- Inbound calls for Members
- Prior Authorization status
- Appeal status
- Send Material request
- Resolving issues
- Claim status
- Data Entry
- Submit Grievances
- Assist with completing member assessments
Supervisor
BroadPath Healthcare
09.2021 - 09.2023
- Oversee at least 35 Agents or more
- Monitor Attendance
- Business Metrics
- Report Team Metrics
- Quality Assurance
- Retrain Agents with failing Audits following checklist and scoring rubric
- Analyze audits
- Data Entry
- CRM Programs
- leadership
- Mentoring
- Problem Solving
Provider Services Representative
DXC Technology
09.2015 - 04.2019
- Facilitated provider onboarding processes, ensuring compliance with organizational standards and protocols.
- Resolved provider inquiries efficiently, enhancing satisfaction and maintaining positive relationships.
- Coordinated training sessions for new team members, promoting knowledge sharing and operational consistency.
- Streamlined communication channels between providers and internal teams, improving response times and service delivery.
- Entry Data
- Provider Inquires
- Resolving issues and Complaints
- Quality Assurance
- Claims Break down and Claim Status
- Authorizations
- Payment Inquires
- Portal Access
Education
High School Diploma -
J.A Fair
Little Rock, AR05-2012
Skills
- Complaint handling
- De-escalation techniques
- Typing speed
- CRM software
- Problem-solving skills
- Time management
- Attention to detail
- Calm and professional under pressure
- Active listening
- Adaptability and flexibility
- Microsoft office
- Medical terminology
- MS office
- Quality assurance
Timeline
Member and Provider Customer Service Rep I
Centene
09.2024 - Current
Member Service Customer Service Rep I
Health Care Solutions
10.2023 - 04.2024
Supervisor
BroadPath Healthcare
09.2021 - 09.2023
Provider Services Representative
DXC Technology
09.2015 - 04.2019
High School Diploma -
J.A Fair
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