Customer Service Manager

Charmaine Ashison

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

Douglasville, GA 30135

*.*******@*****.***

678-***-**** (C)

678-***-**** (H)

PROFILE

. Diversified background encompassing: customer service, quality

assessment, medical terminology, medical claims processing, and office

administration.

. Possess strong organizational and problem solving skills.

. Detail oriented, conscientious, and can quickly establish rapport with

persons from diverse backgrounds and at all professional levels.

. Can work equally well on an independent basis, as a team player, or in

a leadership capacity.

QUALIFICATIONS

Certification and Program proficiencies include:

. MS Office (MS Word, MS Access, MS Excel, MS PowerPoint)

. Oracle

. Lotus Notes

. JAVA

. Business Objects

. CPC (American Academy of Professional Coders)

. ICD-9/HCPCS/CPT Coding (Professional & Facility)

. Data Entry 10,000+ kph.

. Typing 45 wpm

EXPERIENCE

iHealth Technologies 2008 - 2010

Medical Policy

Client Business Analyst I & II

. Ensure that my client's chosen rule set has been implemented

accurately based on the client's decision.

. Understand the client's intent and configure rules to edit based on

the client's expected outcome while ensuring the client's compliance

with local State mandates and/or legal settlements.

. Coordinate and facilitate meetings with the client team to update and

advise on the status of any client changes for each monthly release.

. Responsible for the accuracy and management of the client's rule

configuration in Oracle.

. SME on the impact of any policy modifications to client's current rule

set.

. Provide analysis to the client team to assist in determining what

rules need to be presented quarterly to the client based on the

client's specific rule configuration consideration.

. Research, analyze, and respond to specific client adjudication

inquiries.

. Perform monthly production analysis after each release to assess the

impact of all release additions or modifications to the client's rule

set.

. Generate and analyze daily and monthly reports.

. Research CMS guidelines to ensure the client's rule logic is accurate

and current.

. Manage the new rule set and claim production result for all newly

implemented products.

. Test all new software enhancements prior to company wide software

implementation as a member of the User Acceptance Team (UAT).

. Selected for the pilot team to test and validate the new Citrix Xen

virtual software application.

WellPoint Blue Cross Blue Shield of Georgia 2000 - 2007

Government Programs - State Department

Business Operations Analyst I & II (2005 - 2007)

. Provide research analysis and support for specific projects and

programs within the State Department.

. Assist in the collection and analysis of data in order to formulate

recommendations, policies, or solutions.

. Liaison between Customer Care department and Information Technology

department.Generate reports, create, and maintain spreadsheets for

management team.

. Perform validation and testing of models to ensure adequacy and/or

determine the need for reformulation.

. Assist the management team in the supervision of the Customer Care

department and monitor the Siemens HiPath Observer and CMS Supervisor

systems.

. Assist the management team in conducting interviews and the candidate

selection process.

Senior Customer Care Associate (2003 - 2005)

. Handle escalated supervisor calls for the customer care associates.

. Provide a high quality of customer service while empathizing with the

customer's situation.

. Respond to member and provider inquiries in regards to plan benefits,

claim status, finance/refund issues, and provider network status.

. Review and adjust medical health claims on a complaint basis.

. Act as the back up for the Business Operations Analyst and State

department trainer in their absence.

. Work special projects for management.

. Generate reports and maintain spreadsheets for management.

Quality Auditor II (2001 - 2003)

. Monitor all customer care associates in the State ASO department to

ensure that accurate information is provided to customers while

providing quality customer service.

. Develop action plans to assist management in decreasing the error rate

for individual associates and the department.

. Support business operations analyst in the disbursement of daily

reports to management and department unit leaders.

. A member of the quality control committee ensuring that all updates to

medical policies and procedures are updated in the online manual,

distributed to all associates, and training provided when necessary.

. Complete special projects for supervisors and management as needed.

. Maintained 99% or better on all measured standards.

Customer Care Associate II & III (2000 - 2001)

. Provide superior customer service to customers in a call center

environment.

. Conduct research of customer inquiries in a timely manner.

. Reprocess and adjust health claims.

. Quote insurance benefits to health care providers and plan members.

. Consistently met quality, timeliness, and availability standards on a

monthly basis.

ASCAP 1998 - 2000

Customer Service Manager

. Process all incoming correspondence and incoming calls.

. Act as a liaison with collection agencies.

. Ensure resolution of disputed accounts and customer inquiries.

. Manually debit and credit accounts on the mainframe using data entry

system.

. Train new employees.

. Contribute to the growth and success of the account services

department.

Additional Experience

JBM Retail Inc. - Manager

Afterthoughts - Assistant Manager

Southtrust National Bank - Item Processor

First Fidelity National Bank - Head Teller

First Union National Bank - Teller

EDUCATION

Covenant College - BS in Organizational Management (Graduation Date May

2010)

Atlanta Metropolitan College - AS Biology 1995

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