Desiree Jessie
Atlanta
Summary
A customer service professional with knack for delivering high-quality support and addressing member needs effectively. Equipped with valuable experience in resolving member concerns and enhancing overall satisfaction. Known for strong collaboration skills and adaptability in dynamic environments, coupled with focus on problem-solving and clear communication.
Overview
14
14
years of professional experience
Work History
Senior Member Support Representative
Cognizant TCO / Blue Cross Blue Shield
03.2020 - Current
- Resolve an average of 110+ inbound calls daily, with a 94% first-call resolution (FCR) rate using Salesforce and Avaya.
- Lead peer support sessions to train 15+ new agents on HIPAA, FWA compliance, and CRM protocols.
- Improve CSAT scores by 32% YoY by de-escalating high-frustration situations with empathy and clarity.
- Navigate complex Medicare and Medicaid plan benefits using Market Prominence and EPIC to educate members.
- Document 100% of interactions in compliance with PHI standards and CMS documentation guidelines.
- Process appeals, denials, and coordination of benefits with 98.8% accuracy.
- Manage high-volume escalations and supported internal escalation routing using Zendesk.
- Partner with Quality Assurance team to develop revised call scripting that improved NPS by 18%.
- Handle secure data entry for claim tracking and resolution through Quickbase and Workday.
- Recognized with “Heart at Work” award for consistent member advocacy and service excellence.
Remote Health Care Customer Service Specialist
Teksystems/ AAA
01.2017 - 02.2020
- Handled 90–120 calls/day in English and Spanish, reducing call escalation rate by 26%.
- Delivered benefit clarification, formulary support, and copay calculations during peak open enrollment.
- Resolved 98% of claim disputes within 3 business days, improving resolution time benchmarks by 21%.
- Provided real-time guidance on prior authorization, eligibility verification, and provider networks.
- Processed billing inquiries for Medicare Advantage and dual-eligible members.
- Used Facets and Salesforce for accurate logging of EOB and claims support activity.
- Participated in bi-weekly call calibration and compliance sessions to ensure CMS/FWA standards were met.
- Improved average handle time (AHT) by 17% while maintaining QA call score over 97%.
- Supported case management follow-up by coordinating with providers and internal departments.
- Completed CMS General Compliance and HIPAA Privacy training with perfect assessment scores.
Senior Call Center Representative – Health Services
UnitedHealthcare
08.2014 - 12.2016
- Answered 100+ member calls per shift and maintained 98% adherence to SLA targets.
- Used Genesys Cloud and dual monitor setups to reduce call hold times by 23%.
- Guided members through online portals, virtual services, and digital health support programs.
- Handled Medicare enrollment, claim updates, special enrollment period eligibility, and billing questions.
- Documented and tracked issues using Zendesk and Workday, ensuring audit compliance.
- Co-led improvement initiative that reduced call backlog from 48 hours to under 12.
- Participated in QA reviews and team coaching programs, receiving top marks in empathy and professionalism.
- Managed language line and bilingual member support, increasing member trust among Hispanic communities.
- Reviewed benefit appeals and assisted in EOB interpretation for Medicare subscribers.
- Nominated for “Agent of the Quarter” twice for top-tier performance and team collaboration.
Patient Support Agent – Retail & Pharmacy Ops
Cushman & Wakefield
01.2012 - 08.2014
- Delivered bilingual support across pharmacy billing, health insurance coverage, and prescription claims.
- Resolved billing errors with 96% success rate by coordinating with insurance providers.
- Supported Medicare Part D enrollment campaigns, helping 300+ customers select best-fit plans.
- Processed refill orders, prior authorizations, and copayment clarifications.
- Trained on pharmacy claims, PBM processes, and HIPAA policies during onboarding.
- Logged 100% of member interactions using internal systems aligned with CVS PHI standards.
- Maintained a 97.5% customer satisfaction score over a 12-month rolling period.
- Worked closely with pharmacists and clinical staff to ensure therapy adherence.
- Improved patient wait times by 15% through system queue management.
- Participated in community health workshops supporting seniors and dual-eligible members.
Education
Bachelor of Science - Criminal Justice
Strayer University
Morrow, GA06.2017
Skills
- Complaint handling
- CRM software
- Customer service
- Customer support
- Call center experience
- Banking
- Account reconciliation
- Sales strategy
- Document processing
- Payment processing
- Issue resolution
- Workflow optimization
- Financial transactions
Timeline
Senior Member Support Representative
Cognizant TCO / Blue Cross Blue Shield
03.2020 - Current
Remote Health Care Customer Service Specialist
Teksystems/ AAA
01.2017 - 02.2020
Senior Call Center Representative – Health Services
UnitedHealthcare
08.2014 - 12.2016
Patient Support Agent – Retail & Pharmacy Ops
Cushman & Wakefield
01.2012 - 08.2014
Bachelor of Science - Criminal Justice
Strayer University