Summary
Overview
Work History
Education
Skills
Timeline
Generic

Breona Evans

Greenville

Summary

Healthcare professional with over four years of experience in managed care and healthcare support environments. Extensive background in care coordination, quality improvement initiatives, member education, and compliance-driven documentation. Experienced in supporting large-scale healthcare programs by collaborating with multidisciplinary teams, monitoring performance metrics, and ensuring alignment with CMS, HIPAA, and organizational standards.

Experienced in managing care initiatives aimed at enhancing health outcomes and care coordination, with a focus on preventive service utilization. Successfully handled a high-volume caseload, conducting health risk assessments and identifying barriers to care while collaborating with interdisciplinary teams to align services with clinical guidelines. Maintained compliance with CMS regulations and HIPAA standards through meticulous documentation of member interactions and outcomes. Contributed to quality improvement efforts by monitoring program effectiveness and addressing recurring issues to enhance service delivery.

Compassionate Care Manager with background in overseeing health plans and coordinating patient services. Experience includes collaborating with healthcare professionals, conducting risk assessments, and developing personalized care plans. Strengths lie in strong communication skills, problem-solving abilities, and empathetic approach to patient care. Previous impact includes improving quality of care for patients through efficient management techniques and innovative strategies.

Knowledgeable insurance representative promoting several years' expertise successfully working for organizations. Courteous and cordial with a desire to take on challenges at a new company.

Overview

12
12
years of professional experience

Work History

Care Manager Support Coordinator (healthcare sup.

Centene
08.2025 - Current
  • Care managed care initiatives designed to improve health outcomes, care coordination, and preventive service utilization.
  • Independently manage a high-volume caseload of 40 or more members per day, prioritizing outreach activities based on risk stratification and care gaps.
  • Conduct detailed health risk assessments and social determinants of health screenings to identify barriers to care, unmet needs, and opportunities for intervention.
  • Educate members on individualized care plans, treatment recommendations, follow-up requirements, and available community and health plan resources.
  • Collaborate closely with nurses, providers, and interdisciplinary care teams to align services with evidence-based guidelines and quality benchmarks.
  • Document all member interactions, outreach attempts, and outcomes in accordance with CMS regulations, HIPAA requirements, and internal audit standards.
  • Monitor member progress and program effectiveness, contributing to performance tracking and continuous quality improvement efforts.
  • Consistently meet or exceed productivity, quality, and compliance metrics while working in a fully remote environment.

Customer Service Representative - Medicare Advantage

Blue Cross Blue Shield of North Carolina
03.2023 - 06.2025
  • Supported large-scale Medicare Advantage programs by serving as a primary point of contact for members and providers regarding benefits, claims, authorizations, and coverage determinations.
  • Reviewed prior authorization requests, approvals, and denials to ensure alignment with healthcare regulations, plan policies, and clinical criteria.
  • Explained complex insurance information in a clear, compassionate manner to support member understanding and adherence to care recommendations.
  • Maintained strict confidentiality while handling protected health information (PHI), consistently adhering to HIPAA and organizational privacy standards.
  • Identified recurring issues and escalated trends to leadership to support process improvement and service quality initiatives.

Customer Service Representative

Teleperformance - BCBS Illinois
11.2021 - 01.2023
  • Provided comprehensive member and provider support related to health insurance benefits, claims processing, authorization requests, and medication coverage.
  • Ensured accuracy of information and compliance with HIPAA requirements while working in a high-volume, performance-driven environment.

Dispatcher

Suddenlink / Altice USA
10.2019 - 11.2021
  • Coordinated technician schedules, service routes, and daily workloads across multiple service areas to ensure timely completion of assignments.
  • Maintained detailed service documentation and communicated updates to internal teams to support operational efficiency and customer satisfaction.

Shift Manager

McDonald's
09.2013 - 08.2018
  • Supervised and motivated teams to meet daily operational, productivity, and compliance goals in a fast-paced environment.
  • Monitored performance metrics, trained staff, resolved issues, and implemented workflow improvements to enhance service delivery and team effectiveness.

Education

High School Diploma -

South Central High School
Winterville, NC

Skills

  • Healthcare Quality Improvement
  • Care Coordination
  • CMS & HIPAA Compliance
  • Medicare Advantage
  • Clinical Guidelines
  • Performance Monitoring
  • Stakeholder Collaboration
  • Remote Healthcare Operations
  • Detailed Documentation & Reporting

Timeline

Care Manager Support Coordinator (healthcare sup.

Centene
08.2025 - Current

Customer Service Representative - Medicare Advantage

Blue Cross Blue Shield of North Carolina
03.2023 - 06.2025

Customer Service Representative

Teleperformance - BCBS Illinois
11.2021 - 01.2023

Dispatcher

Suddenlink / Altice USA
10.2019 - 11.2021

Shift Manager

McDonald's
09.2013 - 08.2018

High School Diploma -

South Central High School
Breona Evans