Gabrielle Loftin
Florissant
Summary
Dynamic professional with extensive experience at Cigna, excelling in client outreach and support services. Proven ability to enhance workflow efficiency through data management and effective communication. Recognized for achieving high member engagement and retention while ensuring compliance with industry standards. Strong skills in CRM and collaboration tools drive results in fast-paced environments.
Overview
11
11
years of professional experience
Work History
Community Support Lead Specialist
United 4 Children
St Louis
09.2023 - 11.2025
- Support Senior Manager in development, Implementation, and achievement of recruitment and referral team.
- Monitor and analyze call center trends/back-end to develop and implement processes that enhance workflow efficiency.
- Collaborate with Community support manager to conduct assessments of potential team candidates.
- Provide relevant resources and referrals to clients when requested, i.e., connection to licensing and accreditation offices, childcare programs, family support, and inclusion services etc.
- Provides outreach to members via phone or home visits to engage members and discuss care plan/service plan including next steps, resources, questions or concerns related to recommended care, and ongoing education for the member throughout care/service, as appropriate
- Serve as the first line of communication for providers and families using digital platforms (chat, secure messaging, email, video)
- Assessing the needs of individuals and the community to provide appropriate support and referrals
Claims Legal Representative
Cigna
St. Louis
08.2021 - 09.2023
- Processed patient prescription history record requests, ensuring adherence to performance guarantees, HIPAA guidelines, and service standards.
- Evaluated subpoenas and authorizations for completeness before processing and releasing records.
- Drafted and sent correspondence to members, internal departments, and external agencies regarding the purpose and status of prescription claim records.
- Submitted record reports into the database and assessed system rejections for accuracy and appropriateness.
DOD Claims Representative
Cigna
St. Louis
06.2019 - 08.2021
- Adjudicated claims in alignment with policy terms and conditions, consistently meeting or exceeding established productivity and quality standards.
- Collaborated effectively with internal staff to resolve customer issues, contributing to the achievement of team objectives.
- Develop and implement strategies to streamline processes and increase efficiency
- Identified potential process improvements and made recommendations to enhance team efficiency
Client Services Analyst
Cigna
St. Louis
12.2018 - 06.2019
- Facilitated client interactions by processing vacation overrides, prior authorizations, and managing updates to prescription coverage, ensuring seamless service delivery.
- Assisted clients in researching and understanding claims, and managed request timelines, effectively communicating associated risks and statuses.
- Provided technical assistance to clients; vendors
Prescription Benefit Specialist
Cigna
St. Louis
06.2017 - 12.2018
- Utilized a consultative sales approach to effectively communicate the benefits of mail-order prescription services, enhancing customer understanding and adoption.
- Ensured accurate documentation of all interactions to maintain process quality, uphold HIPAA compliance, and mitigate potential legal risks.
- Collaborated with team members to share best practices, resolve order shipment issues, and maintain seamless operations.
- SME to call center agents; assisted with resolution of complex caller scenarios
Patient Care Advocate (Department of Defense)
Cigna
St. Louis
11.2016 - 06.2017
- Managed inbound and outbound communications with members, providers, and physicians, addressing inquiries related to pharmacy benefits and ensuring adherence to productivity standards.
- Collaborated with operational departments to research and resolve mail order and claims issues, ensuring timely responses within performance agreement guidelines.
- Maintained accurate and comprehensive documentation of all inquiries to enhance the customer service process and mitigate potential legal concerns.
Compliance Specialist
Stifel Nicolaus
St. Louis
08.2015 - 04.2016
- Conducted comprehensive reviews of background checks for brokers and financial advisors, ensuring compliance with regulatory standards.
- Monitored and responded to the Equest system, revised trade violation reports, and managed state requests through CRD, Thomson Beta Systems, and securities registration email.
Benefits Representative
Kelly Services Corp
St. Louis
01.2015 - 08.2015
- Processed and reviewed incoming faxes, including applications, orders, and enrollment forms, ensuring accurate reporting of allergy and adverse events to relevant teams.
- Verified insurance details with healthcare providers, authorized necessary medications, and submitted recertifications for cases requiring extended treatment or coverage.
Education
High School Diploma - General Education
Hazelwood Central High School
St. Louis, MO05.2009
Skills
- Call Documentation
- Client outreach
- Support services
- Data Entry Software
- Database Management
- Remote Work Collaboration Tools
- CRM
- Communication Skills
- Member Engagement & Retention
Timeline
Community Support Lead Specialist
United 4 Children
09.2023 - 11.2025
Claims Legal Representative
Cigna
08.2021 - 09.2023
DOD Claims Representative
Cigna
06.2019 - 08.2021
Client Services Analyst
Cigna
12.2018 - 06.2019
Prescription Benefit Specialist
Cigna
06.2017 - 12.2018
Patient Care Advocate (Department of Defense)
Cigna
11.2016 - 06.2017
Compliance Specialist
Stifel Nicolaus
08.2015 - 04.2016
Benefits Representative
Kelly Services Corp
01.2015 - 08.2015
High School Diploma - General Education
Hazelwood Central High School