Manager Customer Service

BERNICE OLLISON

**** ***** **** *** ****: 702-***-****

Las Vegas, Nevada 89131 e-mail: abimud@r.postjobfree.com

PROFILE

Dedicated professional, with extensive insurance experience. Background includes

indemnity/ppo medical, dental, weekly indemnity and managed care experience. Earned a

reputation for; expert management of high profile policyholders, motivating employees and

exceeding corporate goals. Selected strengths include:

Creative Problem Solving Process Improvement

Proactive Customer Service Project Management

Leadership Teamwork

PROFESSIONAL EXPERIENCE

American Benefit Plan Administrators, Las Vegas, Nevada 2007-2009

Manager, Claims

Management of claims department; including subrogation, appeals, and loss of time.

Implemented, and documented standard operating procedures and workflows. Project

management identifying process improvements and gap analysis. Accomplished annual business

plans including operating budgets. Ensured customer satisfaction by coordinating the resolution

of patient issues.

Sierra Health Services, Las Vegas, Nevada 2003-2007

Manager, Clinic Operations (Southwest Medical Assoc.)

Provided oversight and direct supervision to staff of multiple sites. Developed and produced

monthly key indicator reports and key performance indicators. Monitored business outcomes.

Implemented and maintained business policies and procedures. Responsible for facility planning,

overall facility maintenance, and facility moves. Ensured customer satisfaction within the clinic

sites by coordinating the resolution of patient issues.

Manager, Customer Response and Resolution

Managed a staff of exempt, nonexempt, member services and clinical staff. Responsible for all

aspects/processing/completion of compliance for commercial lines as related to formal

complaints, appeals, grievances and Board of Directors cases within mandatory guidelines,

regulations of federal, state and regulatory entities.

CIGNA Healthcare, Clive, Iowa 1996-2002

Division Manager

Hired, developed and managed 120 employee production division, including work at home,

responsible for servicing medical, dental, and weekly indemnity for 278 groups with a

membership of 314,531. Set and updated measurable performance expectations.

ACCOMPLISHMENTS

• Accountable for managing goals and compliance within administrative discretion financial

risks based upon management decision within case review.

• Analyzed, track and trend for departmental reporting and report compliance at quality

improvement committee, Care Management committee, and Board of Directors quarterly

meetings.

•Chaired weekly grievance committee meetings.

Chosen as one of 26 (50 candidates) company-wide to serve a 2-year commitment as

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corporate Diversity Advocate in addition to regular duties. Delivered “Building an Inclusive

Environment” to managers in various offices 4 to 5 times annually.

Developed action plans for rebuilding relations with troubled customers and achieved

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excellent record of retention.

Selected to serve on national taskforce to increase auto adjudication rates on EDI (electronic)

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provider billings.

Oversaw achievement of goals of 20 performance contract groups with total possible pay-

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out of $7,206,896.81. Improved workflows and developed process improvements to insure

success.

Delivered financial, productivity and quality on plan and in accordance with regional goals

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and commitments. (claim unit cost, expense plans).

Identified, calculated, and then communicated with sales and underwriting on $411,740 in

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optional (nonstandard) expenses, assigned to national optional taskforce as a result.

Supported division in at least 5 third party audits annually.

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Led on-site client visits and attended persistency and finalist meetings at the request of sales

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partners.

Developed Proclaim, an office compensation program for claim processors.

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TRAINING

HIPAA Positive Employee Relations

Conflict Management Maintaining a Positive Workplace

Leadership Development Positive, Power and Influence

NSO Financial Training Team Effectiveness Skills

Writing for Results Managing Process Improvement

CEBS1 and II Kolbe Talent Analysis

Experienced in excel 2007, power point, word, visio, medical terminology, anatomy and

physiology.

Contact this candidate