Omolade Falade

Healthcare Customer Service Specialist with many years of experience supporting insurance, hospital, and pharmacy systems in high-volume remote environments. I have consistently delivered 90%+ CSAT and first-call resolution and resolved complex claims, billing, eligibility, and prior authorization issues. Combining my strong CRM and multi-system expertise with a calm, solutions-driven approach to de-escalate sensitive cases, I ensured accuracy in customer data entry and compliant outcomes.

I am bringing a systems-thinking mindset that improves resolution efficiency and reduces recurring issues, operating independently with full alignment to HIPAA and performance metrics (AHT, QA, CSAT).

Healthcare Customer Service Representative (Remote) at UnitedHealth Group (2024-05 – 2026-04)

• Handled 80–100+ inbound calls daily in a remote call center environment, assisting members with claims, eligibility, and benefits inquiries.
• Delivered first-call resolution by interpreting EOBs, resolving claim denials, and clarifying coverage policies.
• Navigated multiple systems (CRM, claims platforms, knowledge bases) simultaneously while maintaining low handle time and high accuracy.
• Maintained 90%+ CSAT and QA compliance scores by following call scripts, empathy techniques, and active listening.
• Supported members with prior authorizations, referrals, and provider coordination, reducing delays in care.
• Escalated complex cases (appeals, grievances) while ensuring end-to-end ownership and follow-up.
• Ensured strict adherence to HIPAA, PCI, and data security protocols in a remote work setting.
• Mentored new remote agents on call flow, system navigation, and compliance standards.

Patient Care Coordinator at CorroHealth (2023-01 – 2024-04)

• Coordinated patient scheduling, intake, and insurance verification, supporting both in-clinic and remote patient interactions.
• Managed high-volume appointment scheduling and referrals, improving patient access to care.
• Educated patients on billing, co-pays, deductibles, and financial assistance programs.
• Provided remote assistance for patient portals and telehealth appointments, reducing technical barriers for patients.
• Processed payments, account updates, and billing adjustments with high accuracy.
• Collaborated with clinical teams and insurance providers to streamline patient experience and reduce wait times.
• Conducted proactive outreach to confirm appointments and reduce no-show rates.
• Maintained detailed documentation in EHR/CRM systems to ensure continuity of care.

Healthcare Customer Service Representative (Pharmacy Benefits – Remote Support) at Providence Healthcare (2022-03 – 2023-12)

• Assisted members with pharmacy benefits, prescription coverage, and prior authorization requirements in a fast-paced call center environment.
• Resolved issues related to medication access, claim rejections, and formulary alternatives.
• Coordinated with pharmacists, providers, and insurers to expedite prescription approvals.
• Guided members through cost-saving options, co-pay programs, and coverage alternatives.
• Documented interactions in CRM systems while maintaining QA and compliance standards.
• Met and exceeded KPIs for call resolution, handle time, and customer satisfaction.
• Handled sensitive health data while complying with HIPAA and privacy regulations.

Healthcare Customer Service Representative (Pharmacy Benefits – Remote Support) at Concentrix (2019-03 – 2021-12)

• Delivered customer support for healthcare clients in a high-volume remote-ready call center environment.
• Managed inbound inquiries related to appointments, billing, and insurance eligibility.
• Verified patient information and benefits prior to service to ensure accurate billing and reduced claim denials.
• Processed payments and assisted patients with billing questions and account reconciliation.
• Maintained accurate documentation in internal systems to support audit readiness and compliance.
• Consistently met performance metrics (AHT, QA, adherence, attendance).
• Built foundational expertise in healthcare systems, insurance workflows, and customer support best practices.

B.Sc. in Cybersecurity – Western Governors University (2025-06)

Associate Degree in Biology / Biological Sciences – Ogun State Institute of Technology (2015-09)