Kalonni Dee Hester

Results-focused, professional, and highly ambitious Business Administration and Customer Support Specialist with over a decade of experience assisting beneficiaries, resolving issues, and contributing to organizational growth

Referral Management Coordinator II, TRICARE East Region - HUMANA GOVERNMENT BUSINESS - WAH North Carolina

(2018-01)

Processes over 350 referrals a week from the Military Treatment Facilities (MTFs) and civilian providers. Performs varied activities and moderately complex administrative/operational/customer support assignments for beneficiaries in the TRICARE East Region.

• Answers questions or contacts MTFs and/or civilian providers to obtain additional information that may be required to complete provider referral request
• Understands TRICARE benefits/limitations and Humana Military referral processes, MOUs with MTFs, and referral and URAC standards
• Use Medical Management System, assigning an appropriate provider, reviewing benefits for benefits, and/or medical necessity as required to complete referral actions
• Research and resolved complex TRICARE provider issues which may involve certification or credentialing issues, that need to be resolved at higher level
• Works independently on assignments involving complex issues, which requires collaboration with internal and external associates or communicating with provider offices for assistance

Customer Service Support Specialist - XEROS/ACS – Blue Cross Blue Shield - Raleigh, NC

(2013-09 - 2016-01)

Customer Care Support contractor for Commercial Health Insurance Company

• Researched beneficiary/provider complaints, resolved billing issues, and investigated initial cause in order to minimize errors.
• Responded to all inquiries regarding billing issues, benefits, and claim inquiries; educated beneficiaries & providers on self-service tools available on company website/portal.
• Utilized dedicated information system (SharePoint) to track issues/resolution statuses
• Provided Educational Resources to beneficiaries shifting them to use online web portal for routine questions, and answers
• Adhered to beneficiary and company HIPPA, PHI, and PII policy and guidelines in place
• Escalated provider credentialing and/or certification issues to next level supervisor, ensuring warm transfer for provider resolution

Cashier - BOJANGLES

(2004-08 - 2013-09)

Provided Customer Service assignments, greeting customers, handling cash/credit transactions with honesty and integrity, work well with others, and a Team Player

Unit Supply Specialist – E-4 - United States Army - Germany

(2001-02 - 2004-08)

• Received and prepared excess and repairable used parts for reshipment, and general reporting and stock control functions
• Ensured administrative needs were met with daily inventory reports which were presented to senior staff non-commissioned officer in charge
• During 2003 received 100% accountability for third quarter supply inventory inspection valued at $2million in hostile environment
• Reviewed and verified quantities received against contracts, purchase requests, and shipping documents
• Created excel spreadsheets and reports for shortages, deliveries, and equipment request, adhering to US Army Policies and Procedures

Stay at Home Mother

(2016-01 - 2018-01)

Spend 2 years parenting and raising baby boy while using the time to volunteer and pursue other life goals and achievements

Bachelor of Science - Business Administration - Strayer University

Associates of Science Degree - Office Administration - Carteret Community College