SABRINA POKE
Grain Valley
Summary
Detailed-oriented Senior Coordinator with extensive experience in customer service and issue resolution. Skilled in managing complex cases, handling escalations, and ensuring timely resolutions using platforms like Salesforce and Peoplesafe. Proven ability to train and support teams, improve processes, and maintain high customer satisfaction levels. Strong communicator with a proactive approach to problem-solving and a comprehensive background in customer care, having worked across multiple roles with CVS and Aetna to address client needs and enhance service delivery.
Professional consultant with track record of providing valuable insights and strategic solutions to diverse clients. Adept at leveraging analytical skills and industry knowledge to drive impactful outcomes. Known for fostering team collaboration and adapting to dynamic environments, ensuring project success and client satisfaction.
Knowledgeable [Desired Position] with proven background in consulting, delivering strategic insights and effective solutions to clients. Successfully led multiple projects, enhancing operational efficiency and driving business growth. Demonstrated expertise in problem-solving and client relationship management.
Overview
4
4
years of professional experience
Work History
SR ELIGIBILITY CONSULTANT OPS-PSS ENROLLMENT
Aetna, a CVS Health
02.2025 - Current
- Process accurate and timely policy and eligibility data utilizing administration systems for claim payment purposes and product production ensuring services and products meet plan sponsors needs.
- Collaborate with business partners to understand enterprise initiatives and goals.
- Respond to eligibility and other enrollment related issues.
- Partner directly with clients, vendors, internal teams, and/or local claim operation to resolve problems and achieve positive outcomes.
- Anticipate and prevent problems and roadblocks before they occur.
- Solve complex problems and take a new perspective on existing solutions.
- Design, develop and deliver transitional training processes and procedures to smooth the transition for newly hired employees from formalized classroom training to the department's production environment; mentor junior team members.
- Assist with and/or evaluate recommendations involving eligibility reporting solutions and negotiate with internal/external clients.
- Deliver consulting services in support of data discrepancies and/ or involving reporting alternatives.
- Facilitated stakeholder meetings to gather requirements and ensure alignment on project objectives.
- Analyzed client needs to develop tailored solutions, enhancing project outcomes.
Senior Coordinator, Data Administration IFP HICS
Aetna
08.2024 - Current
- Review, triage, and resolve cases for members through Salesforce who are enrolled with Aetna through the federally facilitated Marketplace (FFM) or healthcare.gov.
- Process a variety of complex cases such as Levels 1/2 issues, Congressional Complaints, or cases needing CMS support and insure these priority cases are handled within the established CMS TAT.
- Requests assistance from billing and Enrollment vendors as needed for member requests that require billing and enrollment adjustments.
- Multiple systems used as well as other projects.
- Developed comprehensive training materials for new hires, improving onboarding efficiency and knowledge retention.
- Coordinated cross-departmental projects to streamline operational processes and enhance collaboration.
Senior Service Advocate Analyst
Aetna
01.2023 - 08.2024
- The Sr. Service Advocate serves as the Single Point of Contact for handling member service inquiries, issues and process requests received via telephone using Salesforce for national accounts
- Served as Single Point of Contact for handling member service inquiries
- Acted with fast knowledge using integrated service tools
- Engaged, consulted, and educated members on SIM suite of services
- Performed as an ACAS claims expert, processing systems, policies, and workflows
- Analyzed claims, rework coding claims, and utilized Rumba knowledge EPDB
- Solved problems and interacted with customers to process claims
- Reviewed claims and handled complaints, appeals, grievances
- Mentored trainers and distributed work assignments
- Built trusting relationships, resolved complex issues
- Provided customer service in a transaction-based environment
- Answered calls and resolved issues from members, providers, and plan sponsors
- Protected security of medical records and scheduled appointments
- Highlight your accomplishments, using numbers if possible.
Customer Service Representative
CVS Caremark/ Specialty Pharmacy
09.2021 - 01.2022
- Answered a high volume of calls regarding members' prescription insurance benefits and provided information to the caller.
- Handled a wide variety of customer questions and inquiries both in person and over the phone, always with tact and professionalism.
- Peer assisted learner for several new hire classes
- Assisted with filling members medications and billing inquires.
- Prior Authorization requests and follow-ups
Education
Associate Degree - Business Administration
UMKC
Kansas City, Missouri09.2016
Skills
- CSR
- GPS
- MICROSOFT WORD
- SCM
- SPOC
- TRAINING PROGRAMS
- ASD
- GMAIL
- MICROSOFT OFFICE
- PEOPLESAFE
- SALESFORCE
- OBC
- ECHS
- EPDB
- ACAS
- RUMBA
- HICS
- SOFTHEON WEB
- CLIENT HUB
- WEB CCI
- HRP
- SEED
- SOFTHEON FOUNDRY
- CMSZONE
- REGTAP
- IOP
- MEDCOMPASS
- DOCFIND
- MIRI-OPT-STARS
- CATS
- MICROSOFT EXCEL
- Problem-solving
- Attention to detail
- Team leadership & development
- Client relationships
- MS office
Timeline
SR ELIGIBILITY CONSULTANT OPS-PSS ENROLLMENT
Aetna, a CVS Health
02.2025 - Current
Senior Coordinator, Data Administration IFP HICS
Aetna
08.2024 - Current
Senior Service Advocate Analyst
Aetna
01.2023 - 08.2024
Customer Service Representative
CVS Caremark/ Specialty Pharmacy
09.2021 - 01.2022
Associate Degree - Business Administration
UMKC