Jobilee Grace Pama

Managed a high-volume queue of 30+ daily inbound and outbound calls for US time zone clients, leveraging the Amazon Web Services (AWS) platform for effective service delivery. Executed secure customer data retrieval via the Centene system, strictly adhering to HIPAA compliance and confidentiality standards for sensitive client information. Handled complex financial and claims processes, including payment receipt (using Fiserv), prescription test claims, and intensive coordination with pharmacies and providers. Ensured operational alignment and efficiency through proactive, regular communication and coordination with team leadership via MS Teams.

Conducted in-depth quality monitoring and audits of recorded and live agent interactions (calls and case documentation) related to facility billing, claims, and payment processing. Ensured strict adherence to client service level agreements (SLAs), internal quality standards, and critical regulatory mandates, including HIPAA compliance for patient data confidentiality. Facilitated weekly calibration sessions with Operations, Training, and Client teams to ensure consistency in scoring, policy interpretation, and quality standards for handling complex billing concerns. Provided structured, individualized feedback and coaching to agents and Team Leaders, translating quality findings into targeted action plans to drive sustained performance improvement and high patient satisfaction (PSAT).

Facilitate new hire, product, and process training for customer service representatives, ensuring mastery of client-specific healthcare plans, terminology, and operational systems. Conduct engaging, compliance-focused training sessions using a blended approach: - In-Person (Face-to-Face): Lead classroom sessions for hands-on activities, role-playing, and immediate performance coaching. -Virtual (Online/Remote): Deliver effective training using platforms like MS Teams or Zoom, managing virtual engagement and assessing remote learner proficiency. Design and update training curriculum to reflect the latest healthcare policies (e.g., HIPAA, Medicare/Medicaid regulations), client updates, and BPO process changes.