Customer Service Manager

Melissa Leos

*** ******** *****

Round Rock, TX *8665

512-***-**** *******@*****.***

EDUCATION:

University of Phoenix 11/2005-4/2008

Master of Business Administration/Health Care Management

University of Nevada, Las Vegas 8/1995-5/2000

Bachelor of Arts/Psychology

CERTIFICATION:

Certified Disability Management Specialist 6/1/2010

EXPERIENCE:

Forte, Inc. Telephonic Case Manager

07/03 - Present

. Function as a telephonic case manager providing medical case management

and vocational assistance and coordination services to assist injured

workers in reaching maximum medical improvement and return to work.

Handle 60+ claims as a standing caseload.

. Facilitate and maintain regular communication between all parties

including the injured worker, the claims adjuster, the employer, the

treating physician(s) and ancillary providers to assist the injured

worker in obtaining prompt and appropriate medical treatment.

. Facilitates any temporary or permanent job modifications necessary to

allow the injured worker to return to work within the applicable physical

restrictions assigned by the doctor.

. Develop appropriate treatment plans based on the evaluation of medical

information received using the Official Disability Guidelines (ODG) and

The Medical Disability Advisor (MDA).

. Assess the injured worker and his/her support system and family, making

appropriate referrals throughout the continuum of care including

educational, financial, and psychological or other human services as

indicated.

. Responsible for the collection of outcome information for Quality

Assurance file reviews to determine the impact of case management

activities on timely injury recovery, medical treatment, return to work,

claim costs, and both injured worker and client satisfaction.

. Developed and maintain vocational statistics spreadsheet which tracks

disability duration of injured workers.

. Employ cost containment strategies during case management minimizing the

financial impact on the client.

. Assist in development and revision of case management policies and

procedures.

. Conduct training and develop training materials for new and existing

staff.

. Conduct state research surrounding state specific qualifications and

requirements for Case Management and Utilization Review Management.

. Responsible for the completion of special projects as requested by

executive management and client.

. Solve complex problems and conducts moderately complex analyses.

. Extensive data entry in setting up new referrals into database, as well

as entering medical documentation, and daily contact notes.

Ethel M Customer Service Representative

10/02 - 04/03

. Handled high volume of inbound calls placing orders for various specialty

catalog products.

. Assessed customers' needs and requests and created a positive customer

service experience when processing orders, responding to general

inquiries, checking order status, payment status, returns, exchanges,

stock check.

. Worked with the quality assurance manager addressing and resolving

quality issues on various products.

Paid Prescriptions Customer Service Representative 08/00 -

01/02

. Administered prescription benefits plans for a high volume, inbound call

center.

. Assessed customers' needs and requests and created a positive customer

service experience when processing prescription orders, responding to

general inquiries regarding plan service, medications, billing and order

status.

. Accessed accounts to review and release confidential insurance

prescription plan information, including prescription medication

information.

. Protected the confidentiality of customers' information through careful

screening of callers.

. Determined the appropriate action to be taken to identify solutions in a

timely manner when researching and resolving issues to achieve one call

resolution.

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