Customer Service Manager
Resume:
Drive
Rossville, GA
Phone
Kimalyn Sims
Objective To utilize my education, experience and skills to
advance my career opportunities.
Education 2001 University of Tennessee at Chattanooga
Chattanooga, TN
B.A., Communication
Work experience 2008-2010 BlueCross BlueShield of Tennessee
Chattanooga, TN
Document Support Associate
Creates Member Evidence of Coverage Booklets,
Policies and Group Contracts which includes the
printing and fabricating of the Benefit Riders,
Contract Amendments and Eligibility Pages and
affixing these to the correct benefits requested.
Reviews required legal documents such as Employer
Group Agreements/Change Forms, Renewal Response
Forms, Rate Sheets, Benefits, Riders, and
Eligibility for small employer groups of 100 or less
employee's.
Ensures quality goals are met and customer needs are
satisfied by monitoring the Enrollment Management
Database.
Responsible for accurate and timely update of the
Enrollment Management Database, which is used for
reporting to upper management both internal to the
Membership Division and external to other divisions
within the company.
Verifies and uploads Evidence of Coverage Booklets
for accuracy through electronic system called On
Demand to ensure they are uploaded on web within a
timely manner.
2006-2008 BlueCross BlueShield of Tennessee
Chattanooga, TN
Consumer Advisor
Answered incoming phone calls timely and accurately
taking the appropriate steps necessary to resolve
service inquiries.
Ensures timely and accurate written and/or phone
responses to customer inquiries.
Documented and logged all phone calls regarding
subscriber inquiries.
Maintained telephone accessibility of 6.5 hours
while minimizing "not ready" time to less than 30
minutes per day.
Maintained level of excellent customer service by
ensuring customer inquiries were handled within 3-5
day turnaround time.
Verified all phone inquiries are finalized.
2005-2006 CIGNA Healthcare
Chattanooga, TN
Contract Analyst
Created Evidence of Coverage Booklets or Summary of
Products Design Booklets for Middle Market Groups of
500 or more employer's according to state and
federal regulatory guidelines.
Reviewed and analyzed implementation materials to
create contract documents for new and existing
business.
Created, prepared and printed Policy Contracts and
Benefit Riders for individual plan products.
Analyzed benefits to ensure compliance with
applicable state and federal legislation.
Entered benefits into system.
Researched, coordinated information and responded to
questions from internal partners and /or external
clients.
Participated in bi-weekly meetings with account
manager's or representatives.
Negotiated deliverables with account manager's
internal/external partners 96% of the time.
Maintained production metrics of 15 documents per
month as well as quality metrics of 98% per month.
Received a Cigna "Champions Award" for assisting in
the development of training materials for Plan
Automation Training Class.
1999-2005 CIGNA Healthcare
Chattanooga, TN
Quality Reviewer/Trainer
Trained and audited Full-Time, Part-Time and
Temporary employees.
Reviewed and inspected claims for accuracy for 6
separate processing systems CPR (Eligibility
System), PMMS (Provider Network System), RDE
(Automated Claim System), I-Track (Claim Tracking
System), Proclaim (Claims System) and processing of
Dental claims.
Provided monthly and quarterly report to employees,
supervisors and management.
Provided any employee up-training requested by
employee or management.
Trained and supervised 25 employees off site on
claim processing procedures and guidelines.
Identified and communicated error trends and
provided feedback with recommendations to reduce
errors.
Developed 2 manuals according to policy and
procedures in an effort to improve quality control.
Participated on the quality task force team which
improved quality and benefited analyst and
auditor/trainer relationships.
Received Cigna "Circle of Excellence Award" for
assisting in a project which improved quality
results.
1997-1999 CIGNA Healthcare
Chattanooga, TN
Eligibility and Enrollment Analyst
Reviewed and processed membership applications and
change/termination forms.
Researched, analyzed and resolved eligibility issues
including loading and terminating members/dependents
in accordance with group master contract provisions,
federal/state mandates and corporate guidelines.
Updated provider network changes.
Point of contact for Human Resource departments.
Answered and resolved issues for customer
representatives.
Answered questions by telephone and correspondence
from other associates, managers, accounts and/or
subscribers.
Skills and
Capabilities
0.
Ability to interact effectively using excellent written
and verbal communication.
1. Ability to train and lead others.
2. Takes initiative and easily adapts to fast pace changing
environments.
3. Ability to work independently as well as part of a team.
4. Ability to multi-task.
5. Proven ability to exercise good judgment.
6. Requires minimal supervision.
7. Legal Terminology and Medical Terminology.
8. Solid PC skills with experience using Excel and Word.
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