Customer Service Manager

MARTIN SCHWARTZ

Cell 281-***-****

******.**********@*****.***

OBJECTIVE

Business Management/Analytics

Healthcare Management/Analytics

Operations Management/Analytics

SUMMARY

Over 20 years of experience in various management positions. Successfully

managed operations and business processes, which exceeded targeted

financial results. Achieved a 60% overall increase in customer

satisfaction. Proven track record of streamlining workflow processes,

analyzing critical data and the ability to develop and build successful

teams. Recognized for excellent interpersonal and team leadership skills by

employees at all levels of the organization.

PROFESSIONAL EXPERIENCE

RESCARE - Houston, Texas

Financial Aid Call Center Supervisor

March 2012 to November 2012

. Responsible for weekly payroll time sheets and attendance.

. Reviewed and responded to appeals & grievance issues.

. Performed case management QA reviews.

. Performed staff performance reviews and disciplinary actions.

. Live monitoring of customer service calls and monitored call center

service levels.

. Reviewed and responded to internal/external customer inquiries and

escalated customer calls.

. Developed weekly production reports and provided constant feedback to

staff.

. Developed and analyzed monthly key performance indicator report for

management.

. Managed all workflow and process improvements.

. Conducted health and safety reviews and training within the Call

Center.

UNIVERSAL AMERICAN (Heritage Health) - Houston, Texas 2007 - 2011

Metrics Production Manager & Business/Project Analyst (2008 - 2011)

. Developed reports for key performance indicators for business owners and

executives which provided vital information for managing the business.

Analyzed and reported key performance indicators and trends of

production, quality, and general operations derived from complex data

mining and external sources which provided the basis for management

decision making. Considered Claims department SME.

. Directed a SQL team of up to 10 both domestic and international,

developing them into a highly productive unit that helped reduce

operating costs while increasing production. Produced daily, monthly, and

yearly reports that were error free and accurately represented all data

analyzed.

. Developed a systematic approach for business owners to request ad hoc

reports which were produced within the regular work day, or no later than

24 hours from time of request depending on complexity.

. Conducted business user meetings to gather requirements and translated

requirements to technical specifications. Ensured issues were

identified, tracked, reported on and resolved in a timely manner.

. Facilitated meetings between operating departments, vendors, and clients

which addressed critical issues and helped participants reach consensus

on an appropriate resolution.

. Reviewed department operations by mapping workflow processes to identify

areas for improvement. Created and maintained workflow processes and

mapping for SOX compliance and reporting. Maintained SOPs and processes

on Sharepoint. Implemented continued quality improvements which

increased productivity and overall customer satisfaction.

. Facilitated system conversion strategies, gathering information, end user

testing, QA and training. Ensured issues were identified, tracked,

reported on and resolved in a timely manner.

UNIVERSAL AMERICAN (Heritage Health) - Houston, Texas

Facilities Manager (2007 - 2008)

. Enhanced the relations with building management which increased services

required as well as lowering response time.

. Served as contact for repairs, coordinated work and ensured 100%

completion.

. Responsible for renovations and build outs of operations.

. Coordinated and monitored Health & Safety training in conjunction with

Human Resources.

. Managed the mailroom intake and document scanning center directing the

activities of a staff of up to 10. Reduced the backlog of document

scanning from 3 months on hand to 1 day on hand within 6 months.

THERAPEUTIC MASSAGE SERVICES (Self employed) - Houston, Texas 1998 - 2007

Therapist/Instructor

. Provided therapeutic services to clients.

. Marketed and grew business to 100+ clients in a period of less than two

years.

. Earned a certified instructor designation from the state of Texas and

served as a school based instructor in Houston. For one school, served as

school Director which included responsibility for student admissions,

retention, financial accountability, scheduling classes, management of

the intern clinic and health and safety.

HEALTH SOURCE MEDICAL GROUP - Los Angeles, California 1995 - 1997

General/Operations Manager

. Managed all department operations of the Medical Group, including claims,

enrollment, customer service, contracting, provider relations, marketing,

UM, quality assurance, case management, human resources and finance

departments. Reported to the Vice President/Medical Director of this

company employing approximately 100.

. Maintained a constant level of operating expenses in a highly volatile

market of increased competition and rising costs.

. Ensured compliance with all federal and state regulatory agencies, as

well as company and client audits, passing all audits when initially

conducted.

. Established company policies & procedures and work flow processes which

assured operations were conducted as efficiently as possible.

. Approved contract negotiations with health plans and providers ensuring

agreements were favorable to the company.

. Responsible for all facets of facility management of medical group and

two additional medical offices including health and safety.

CAREAMERICA - Woodland Hills, California

1993 - 1995

Claims Manager

. Managed the Commercial and Medicare HMO and PPO claims processing and

customer service departments. Coached and mentored staff of 75

employees. Reduced turnover significantly by encouraging individual

contribution, the opportunity to grow, and being open to new and

innovative ideas.

. Developed policies and procedures that increased efficiency and ensured

consistency of resolving problems.

. Reviewed production and quality performance meeting targets 99% of the

time.

. Conducted performance reviews and disciplinary actions.

. Prepared and managed the annual budget forecast.

. Performed client presentations and system demonstrations which increased

the clients' understanding and by-in to the services provided.

PRUDENTIAL INSURANCE - Woodland Hills, California 1976 - 1992

Associate Claims Manager (1989 - 1992)

. Managed Indemnity, PPO, and HMO claims processing, coaching and mentoring

a staff of 50 employees. Increased internal employee satisfaction by

providing tools and training to be successful and realize advancement

opportunities.

. Developed policies & procedures that ensured consistency and developed

production and quality standards that were a stretch, however attainable.

. Conducted performance reviews and disciplinary actions.

. Prepared and managed the annual budget forecast.

. Performed client presentations and system demonstrations which increased

the clients' understanding and by-in to the services provided.

Claim Consultant (1986 - 1989)

. Conducted claim reviews and audits of home office and field office

locations which ensured compliance with company policies and state and

federal mandates.

. Developed policies and procedures which reflected new or revised company

standards, as well as, State and Federal regulations.

. Oversaw project management for the development, enhancement, and testing

of systems.

. Communicated to DOI and DOC inquiries and complaints, both verbally and

in writing.

. Reviewed high dollar claims, BR, and multiple surgeries for appropriate

adjudication.

PRUDENTIAL INSURANCE - Woodland Hills, California 1976 - 1992

Provider Relations Manager (1985 - 1986)

Medical and Dental Claims Supervisor (1981 - 1985)

Medical and Dental Claims Technician (1979 - 1981)

Medical and Dental Claims Examiner (1976 - 1979)

EDUCATION

AA Degree in Business Administration - Valley Jr. College, Van Nuys,

California

TECHNICAL SKILLS

Facets AS400 Visio Medicare HMO, PPO &

Macess Excel PowerPoin FFS

EZ-CAP Word t Medical Terminology

Avaya Outlook SharePoin CPT, ICD, HCPC & DRG

t

DocuWare

ADDITIONAL EDUCATION

Time Management - Franklin and Time Institute

Managing Priorities - Zinger Miller

Managing Diversity - Coleman Management Consultants

Managing Professional Development - Prudential

Team Building/Problem Solving - Prudential

Medical/Dental Coding - Prudential

Risk Management, Integrated Framework of Control - Prudential

Injury and Illness Prevention - CareAmerica

Age Sense and Aging Awareness - CareAmerica

Teaching Adult Learners - Texas Department of Health Services

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