Senior Member Experience Representative Resume

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Senior Member Experience Representative Resume Grayson Doyle Senior Member Experience Representative (713) 555-XXXX grayson.doyle@example.com graysondoyle Houston, TX 77008 STRENGTHS Empathetic service When members raised difficult concerns, listened carefully and responded with clear, respectful explanations suited to their situation. Calm resolution Handled challenging calls by acknowledging the member’s concern and explaining next steps, including when a request needed further review. Reliable follow through Recorded commitments and outcomes so colleagues could continue an inquiry without asking members to repeat key details. Member advocacy Coordinated unresolved benefit and clinical service questions with internal teams to help members receive complete responses. Practical improvement Shared recurring member feedback with supervisors, helping refine guidance for common claims and enrollment questions. SKILLS Medicare Advantage support Inbound inquiry resolution Benefits and claims support Enrollment assistance Clinical services navigation Member advocacy Active listening Call de-escalation Personalized member support CRM record review Interaction documentation Feedback trend reporting Process improvement HIPAA privacy practices Regulatory compliance LANGUAGES English Native 40 Spanish Intermediate 20 MY CAREER 9.2 Years Senior Member Experience Representative at Cedar Ridge Health Plan (2.7 Years) Member Services Representative at Pioneer Benefit Administrators (2.8 Years) Claims and Enrollment Support Associate at ClearPath Health Services (2.4 Years) Patient Access Representative at Westlake Community Health Network (1.4 Years) SUMMARY Customer experience professional with 9 years of experience supporting health plan members and patients across Medicare Advantage, benefits administration, and clinical access. Provide clear, empathetic help with benefits, claims, enrollment , and clinical services , using active listening to understand concerns and guide members toward resolution. Coordinate with internal teams, document interactions, and share feedback that informs practical service improvements. Apply HIPAA privacy practices and established procedures when reviewing member information, protecting confidentiality throughout high volume service interactions. EXPERIENCE Senior Member Experience Representative Cedar Ridge Health Plan Mar 2024 - Present Houston, TX Respond to inbound Medicare Advantage inquiries through phone and secure messaging, clarifying coverage, claims status, enrollment details, and next steps so members can make informed decisions. Resolve sensitive benefit and clinical service concerns by reviewing member information in CRM and plan systems, explaining available information in plain language, and coordinating follow up with clinical and claims teams. De-escalate difficult calls by listening for the underlying concern, acknowledging its impact, and tailoring explanations to the member’s circumstances, including when a request needs further review. Record interaction details, commitments, and outcomes in member information systems , supporting accurate interaction documentation , handoffs, and consistent follow through across service teams. Summarize recurring member feedback and process obstacles for supervisors, contributing practical recommendations that improved guidance used during common claims and enrollment inquiries. Apply operational procedures and HIPAA privacy practices when verifying identity, accessing member information , and escalating potential compliance concerns. Member Services Representative Pioneer Benefit Administrators Jun 2021 - Feb 2024 Austin, TX Managed a steady queue of inbound member inquiries concerning health plan benefits, claims explanations, enrollment changes, and access to clinical services, using plan resources to provide accurate answers. Coordinated unresolved claims and coverage questions with internal operations teams, documenting the issue and member’s preferred contact method to support a complete response. Helped members understand eligibility and enrollment timelines by comparing account details with plan records and explaining actions needed to address discrepancies. Identified repeated confusion in call notes and shared examples with team leads, supporting revisions to member facing explanations and service procedures. Protected confidential records by following identity verification and information handling requirements during each service interaction. Claims and Enrollment Support Associate ClearPath Health Services Jan 2019 - May 2021 San Antonio, TX Reviewed claims and enrollment inquiries for a regional health services support team, locating relevant account details and routing cases to the appropriate internal specialists. Explained claim status, benefit terminology, and required enrollment documentation in clear language, reducing unnecessary transfers and helping members understand available next steps. Maintained detailed case notes in CRM and claims administration systems so colleagues could continue complex inquiries without requiring members to repeat essential information. Flagged recurring processing questions for the team’s weekly service review, helping refine reference materials and improve consistency in member responses. Patient Access Representative Westlake Community Health Network Aug 2017 - Dec 2018 Austin, TX Supported patients calling about appointment access, clinical service referrals, and coverage details, verifying records and directing clinical questions to appropriate staff. Recorded calls and follow up needs in the patient access system while observing confidentiality procedures, giving care teams a reliable account of outstanding requests. LEADERSHIP, AWARDS & RECOGNITION Recognized by a service supervisor in 2025 for clear, compassionate handling of complex member concerns. Shared peer coaching on call documentation and respectful de-escalation practices with new team members at Cedar Ridge Health Plan. EDUCATION Bachelor of Arts in Communication Studies Texas State University 2014 Texas CERTIFICATIONS AHIP Medicare Training 2024 HIPAA Privacy and Security Training 2025 PROFESSIONAL SKILLS Member Service Systems: CRM platforms, claims administration systems, enrollment systems Contact Channels: Telephone systems, secure messaging platforms, call routing systems Health Plan Records: Member eligibility databases, benefits portals, claims status tools Patient Access Platforms: Appointment scheduling systems, referral management systems, patient registration systems Documentation Tools: Electronic case notes, interaction tracking systems, service knowledge bases Privacy and Security Tools: Identity verification systems, access control systems, secure data handling platforms SKILLS Medicare Advantage support Inbound inquiry resolution Benefits and claims support Enrollment assistance Clinical services navigation Member advocacy Active listening Call de-escalation Personalized member support CRM record review Interaction documentation Feedback trend reporting Process improvement HIPAA privacy practices Regulatory compliance PROFESSIONAL AFFILIATIONS Member, National Association of Healthcare Access Management, connecting with peers focused on patient access and service practices. Member, American Association of Healthcare Administrative Management, engaging with professionals in healthcare administration and member support. LANGUAGES English (Native) Spanish (Intermediate)

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