Customer Service Quality Assurance

Sherrie Groff

651-***-**** ( *******@*****.***

Career Summary: Experienced administrative assistant with excellent

customer service and problem solving skills in the health care,

promotional, and retail industries. Exceptional communication skills with

the ability to quickly develop rapport. Self motivated with a strong

initiative to achieve results. Knowledgeable in Microsoft Office Suite.

PROFESSIONAL EXPERIENCE

OptumHealth

2010

Engagement Specialists

. Responsible for making inbound and outbound calls to new consumers to

engage them into a new program that is a part of their benefit package.

.

HEALTHWAYS

2003-2009

Senior Provider Service Assistant

. Directed inbound call routing and provided administrative support for

management and nursing staff of 100.

. Managed telephonic support for end-users of web based applications and

incentive programs.

. Engagement specialist responsible for making outbound welcome calls to

new members.

. Maintained LEAD role for customer service contract and managed escalated

issues.

. Created FAQ and workflow documents and delivered training on contract

changes.

. Implemented and MANAGED project to change outbound call delivery

mechanisms focused on maintaining quality, providing clear communication

channels, and working with cross-functional teams.

. Promoted TEAM UNITY and culture instrumental in successful project

implementation and delivery of quality customer experience.

. Trained and MENTORED all new customer service personnel.

. Developed quarterly access reports for all contracts and reported results

to corporate office.

. Produced daily report to identify trends summarized for quarterly report.

. Maintained database for clinicians to manage metric and goal attainment.

. Conducted AUDITS of new entries to ensure data integrity.

. Queried database to identify new, unduplicated members and processed

eligibility verification.

. Ensured accurate double-entry of members into separate data

warehousing.

. Attended Culturally and Linguistically Appropriate Services

(CLAS), Practicing Disease Management Using a

Computer-Based Medical Information Systems, and Sources of

Personal Power continuing education seminars.

IDENTITY PROMOTIONS

1997-2003

Office Manager/Customer Service Representative

. Provided administrative support and directed inbound calls for

promotional materials company.

. Placed, processed, and shipped orders to clients.

. Quoted appropriated pricing for customer projects.

. Maintained vendor relations to verify orders and obtain progress updates

and ensure timely delivery to customers.

. Entered data into fulfillment database to track deliverables.

BLUE CROSS AND BLUE SHIELD OF MINNESOTA

1970-1996

Sr. Utilization Review Analyst

. Reviewed medical practices to determine overutilization of benefits or

fraud.

. Conducted audits with nurses and physicians to determine fraudulent

practices.

. Submitted overpayment letters to request overpayment refunds.

Quality Assurance Representative

. Audited report data to determine coding accuracy of claims.

. Ensured HIPAA compliance and accuracy.

Claims Examiner

. Coded claims by entering them into the system

KOHLS

2001-Current

Sales Associate

. Point of Sales Supervisor from 1999-2001

. Point of Sales Trainer from 2001-Current

. Maintain customer service focus for retail organization.

. Complete efficient zoning of department and provide back-up

support for cashiers.[pic]

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