Customer Service Quality Assurance
Resume:
Lillian I. Woodard
**** ****** ***** *****, ********, GA 30058 *********@*****.***
Objective
To obtain a Managerial position in Client Service Benefits Administration
or Customer Service training in benefits and education.
Education & Qualifications
Midwest Theological Institute, Bachelors of Theology, 2010, Decatur, GA
CIGNA Healthcare, Cobra Compliance Systems, Annually 1990 - 1999, Atlanta,
GA
CIGNA Healthcare, Train the Technical Trainer Certificate, 1998, Hartford,
CT
CIGNA Healthcare, Creative Training Techniques, 1997, Atlanta, GA
HCA, Norcross, GA, 05/05-11/08
Optical Claims Examiner
Researched hospital and patient claim concerns that were requested by both
the hospital and patients
Investigated non-payment, delayed payments or rejected claims, and
confirmed denial accuracy of all claims and disputes
Responsible for follow up with the patient review board
Refunds Analyst
Received hospital claims and patient refund requests from network
hospitals and patients
Researched patient profiles and applied refunds to open hospital claim
accounts
Notified hospitals and patients if credit is applicable and refunded or
applied credits to patient's open accounts
Ablest Temporary Agency and Insurance Overload Atlanta, GA, 04/02-04/05
Builders 1 Source Customer Service Specialist
Received and researched customer orders and inquiries for all building
supplies
Set up billing and pay schedules, reviewed back orders, and orders on hold
or not received
HCA medical - 5/2005- 12/2005
Refund Specialist- Position became permanent in December 2005
CNA Unisource, Marietta, GA, 12/00-11/01
Client Service Manager
Managed enrollment process for new 401K plans, dental, medical and life
insurance plans
Managed new client enrollment during open enrollment periods for various
companies
Maintain HRIS and payroll updates throughout the year
Acted as the point of contact for all HR inquiries and assisted clients as
needed
Informed and educated clients on HR and client service related issues
Preferred Plan of Georgia 5/00 - 11/00 Provider Service Coordinator
Maintained provider data for directory
Assisted in physician recruitment
Prepared statistical reports correlated marketing material.
Reviewed network marketing material
Reviewed network for provider enrollments and termination
Strickland General 9/99-4/00 Accounts Receivable I (Temporary)
Receive premiums from clients, for property and casualty insurance,
prepare monthly financial statements for corporate reconciliation.
CIGNA Healthcare of Georgia 3/90-7/99
Nov 1994-July 1999 Member Education Training Specialist
Member quality control coordinator for internal staff
Designed 4 week training class for new customer service representatives
and evaluated skills and retention during probation period
Created state guideline service manuals, combining internal company
policies and procedure manuals.
Implemented pre-call assistance for frequently asked questions
Produce work study programs to assist in continuing quality of care
90 monitoring review and assessment
New hire training skills assessment for phone staff and external
customers
Lead source for Cobra compliance
Georgia legislation specialist
Quality management team for CQI (Client Quality care Interviews)
National trainer certification program
March 1990- Jan 1996 Customer Service Representative
Educate customers internal/externally on medical utilization
Liaison for providers, hospitals, benefits officers, client sale
representatives
Supervised and negotiated problem-solving techniques with group
administrators
Assisted in revision of membership workflow, through quality assurance
Educated product utilization for HMO, PPO, POS, ASO and traditional
carriers.
Processed and coordinated group eligibility and enrollment
Eligibility Workflow Coordinator
Blue Cross/Blue Shield of Kentucky 11/1979-11/89
Group Audit/Billing Analyst
Responsible for the accuracy of group & subscribers monthly enrollment
and billing
Supervised over 100 companies with their membership and billing
insurance needs
Liaison for underwriting, sales, eligibility department on membership
inquires
Membership and Billing Analyst
Researched and established new/reclassed enrollments
Canceled/Added pending subscribers
Researched and resolved claims issues and concerns
Established data for new enrollees
Ordered enrollment packet and new benefit information
Contact this candidate