Customer Service Quality Assurance

OBJECTIVE: Pursue a career in Healthcare Administration and Management

SUMMARY:

. 10 years call center experience

. 6 years experience in managed health care and claims processing

. 5 years supervisory experience

EDUCATION:

New England Institute of Technology, Warwick, RI

Bachelor of Science Degree in Business Management Technology, Oct 2003-

May 2006

Associate of Science Degree in Electronics Engineering Technology, Oct

2000-May2003

Salve Regina University, Newport, RI

Currently enrolled in the Master of Science-Healthcare Administration

and Management

EXPERIENCE:

COMPREHENSIVE COMMUNITY ACTION PROGRAM (Community Health Center), Cranston,

RI June 2009 - December 2009

Contact Center Manager

. Entirely responsible for Contact Center start-up, including project

management roll-out, internal procedures, recruiting, training and

evaluation of staff.

. Recommended, developed and implemented short- and long-term quality

service strategies to improve contact center operations and caller

satisfaction

. Analyzed operational data and made data-driven recommendations for

scheduling, staffing, and process improvement

. Assisted IT Department with updates and changes to the AXXESS phone

systems

PEROT SYSTEMS INCOPORATED, Providence, RI

April 2007 - December 2008

Customer Service II/Claims Adjuster/BPS

. Reviewed and adjusted 2,000+ claims a month according to customer

guidelines in the Priority Unit Department for the Blue Cross Blue Shield

of Rhode Island account.

. Researched inbound transaction requests and documented actions taken on

claim adjustments.

. Quality control claims entered by oversees data entry staff.

BLUE CROSS BLUE SHIELD OF RHODE ISLAND/ARKANSAS, Providence, RI

July 2002 - June 2006

Customer Service Representative/Operations Case Worker

. Maintained satisfactory call statistics while responding to a high volume

of inbound calls for Federal Medicare beneficiaries,

physicians/suppliers, providers, other insurance companies, employers,

and congressional staff.

. Responded to over 360 written and telephone inquiries per week and took

corrective action on all claims for final adjudication.

. Assisted members of the public with Medicare benefits and coordination of

all special Medicare Secondary Payer recovery activities and IRS/SSA.

. Handled calls and adjusted claims as a dedicated representative on the

Provider Appeal queue.

. Provided education, training and coaching to new hires, to ensure

appropriate use of various medical software applications and accurate

information was delivered to customers.

MIAMI DEPARTMENT OF ENVIRONMENTAL RESOURCES MANAGEMENT, Miami, FL

January 1997-September 2000

Clerk II

. Responsible for maintaining 17,000 plus records and scheduled

appointments to review files.

COMPA IA DOMINICANA de TELEFONOS (CODETEL), Santo Domingo, DR

August 1989-February 1994

Quality Assurance Supervisor

. Provided training, coaching, feedback and assistance to call center

representatives to ensure staff was up to date with new policies and

procedures for quality.

SKILLS SET:

Bilingual: Proficient in English and Spanish

Computer and Technical skills: Proficient in Windows XP, Word, Excel,

PowerPoint, Outlook 2000, Lotus Notes, LRSP Mainframe, Contact Center

Suite, blue LYNCS Pega, MACESS, Folders, Nextgen, FISS, CWF, MCS, Kronos,

AXXESS and AVAYA phone systems.

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