Customer Service Quality Assurance

Denise Alexander

( ***** Chalfonte, Detroit, MI *8227

( (H) 313-***-**** (C) 313-***-**** ( ********@*****.***

Topnotch and Dedicated Management Professional

Customer Service/ Human Resources/Training

with over 20 years successful experience paired with

Master's Degree in Organizational Management

Hardworking, enthusiastic, tenacious professional with exceptional

interpersonal skills and first rate management skills

SUMMARY OF QUALIFICATIONS

. Diverse professional development, including customer relations, office

management procedures and personnel issues.

. Gifted communicator with proven ability to form strong relationship with,

and gain trust of colleagues, and clients of all level.

. Superior troubleshooting, problem solving and conflict resolution skills,

with exceptional focus and follow-through abilities.

. Experienced in overseeing multiple tasks with varying priorities, working

with various departments within an organization to ensure smooth

operation and productivity with a strong record of moving beyond limiting

questions.

. Adept at developing and implementing strategies, policies, and

procedures.

. Work effectively under pressure and demonstrate flexibility to meet

deadlines.

. Proficient with Microsoft Office and Internet.

CORE COMPETENCIES

Training and Program Design Strategic Planning Claims and

Benefits

Procedure Evaluation Problem Resolution Quality

Assurance

Performance Development Program Coordination Hiring and

Mentoring

Management Instructional Development Leadership

PROFESSIONAL EXPERIENCE

UNICARE INSURANCE COMPANY, Dearborn, MI

Manager-Customer Care 01/2004 to

12/2008

Managed various disability activities related to quality performance

programs for Ford Motor Company. Hired as the first-ever trainer in

disability unit of the company.

. Orchestrated a number of human resource management duties, including

hiring, training, coaching, counseling, and evaluating performance of

direct reports.

. Oversaw 50 Case Managers to ensure accurate files coding and adequate

documentation to meet statues and regulations, company disability

plans/contracts and service standards.

. Increased turn-around time of payments by improving information

gathering from paper system to calling physicians/employees.

. Trained over 100 associates-Clerical, CSR's, Claim Managers, Nurses,

Team Leads, Managers, and Auditors.

. Built a strong Quality Team fostering independence as well as a

cohesive productive team environment to ensure only the best quality

performance standards.

DENISE ALEXANDER PAGE TWO

. Developed and authored a number of successful processes and procedures

for disability unit.

Training Specialist 03/2001 to

12/2003

. Developed and delivered training to associates, increasing

understanding of policies procedures, regulations, and technologies.

. Selected and developed effective training, including aids as training

handbooks, demonstration models, visual aids, and reference works.

. Facilitated skill-based classroom training pertaining to claims

administrations.

Blue Cross Blue Shield of MI, Southfield, MI

Jawood Management Associates, Troy, MI

Analyst-Instructional Developer 04/2000 to

03/2001

. Implemented successful project implementation, documentation, and

training course administration

. Developed on-line and written documentations for operational purposes.

. Improved standards focused on building high achieving employees with

demonstrated responsiveness and confidentiality.

. Worked closely with subject matter experts (SMEs), which include

system analyst, supervisors, and team leads.

. Represented department and division on work groups and special

assignments.

Metropolitan Life Insurance Company, Southfield, MI

Supervisor 1-Customer Service Call Center 06/1998-

04/2000

Managed Customer Service Representatives to maintain highest standards of

customer service, with emphasis on customer satisfaction levels and prompt

resolution of customer problems or concerns.

. Designed training programs-content and structure.

. Managed telephone statistics and queues using Meridian Terminal

Emulator (MTE).

. Performed Quality Assurance Coaching and audits for Customer Service

Representatives.

Benefits Representative 04/1988 to

06/1998

Responsible for investigation and documentation of short-term and long-term

claims for group policyholders; authorized claim payment; interacted with

claimants, medical professionals and other vendors. Maintain awareness of

ERISA, Fair Claims Practices Model Act, HIPAA, and state -mandated laws.

. Analyzed disability claims to determine benefits due as well as

ongoing adjudication of claims within company standards and industry

best practices.

. Analyzed claims (caseload of 150+) and determined appropriate actions.

. Liaised with doctors and medical staff for medical records; Partnered

with doctors/nurses to help claimants return to work within 12 months.

. Effectively maintained 5-day backlog/issue payments in excess of

$5,000 per month

. Coordinated the recovery of disability overpayments, including

Workmen's Compensation overpayments, with the claimants and

appropriate units.

EDUCATION

Masters Degree in Organizational Management-University of Phoenix,

Southfield, MI

Bachelor of Arts Degree in Business Education-Huston-Tillotson College,

Austin TX

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