Customer Service Project Manager

Crystal M Brewer

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

Franklin Township New Jersey 08873

Home: 732-***-**** - Cell: 973-***-****

Email: **********@***.***

EXPERIENCE

Medical Claims Supervisor, Horizon-BCBSNJ, Newark, New Jersey

2006 - 2009

. Trained and managed claims outsourcing vendor staff of 43 while

monitoring daily inventory and production reports

. Developed and maintained internal and external relationships to

support service level agreements and internal workflows for claims

processing department

. Outlined and implemented performance plan goals, which included

coaching, mentoring, training and identifying career goals

. Monitored and reported on daily, weekly, monthly and quarterly quality

reports to ensure accurate inventory management and timely processing

of physician and hospital claims

. Supported and encouraged staff as they built relationships with

various departments including, enrollment, implementation, sales, and

customer service support teams

. Played an active and supportive role to the Project Manager in

workgroups as a technical expert on managed care line of business

claims processing engines

. Created and managed presentation and preparation for quarterly inter-

department town meetings

. Lead team in managing and reducing overall managed care claims

inventory

Training Analyst, Horizon-BCBSNJ, Newark, New Jersey

2003 - 2006

. Researched, designed, developed, coordinated, maintained, and created

course and training materials, classroom curriculum and schedules for

new and existing employees, external vendors and internal customer

Sr Provider Relations Rep, Horizon-BCBSNJ, Newark, New Jersey

1998 - 2005

. Developed and maintained strong relationships with participating

physicians/health care professionals and County Medical Society, IPA's

and vendors

. Ensured current initiatives were included and discussed in new

provider training packages

. Completed special arrangement termination coversheets with required

recommendations

. Trained and mentored new field consultants

. Explained and facilitated Physician and Pediatric Incentive Program to

the physicians

. Helped to implement provider community from hard copy claim

submissions to electronic submissions

. Educated physicians/health care professional office staff to use the

online physician website portal tools and functions

. Planned and organized physician's seminars, lectures, and conventions

to ensure effective distribution of communications of all current

company initiatives and products

. Responded to telephone inquiries and written correspondence from

physicians/health care professionals that required additional

resolution - not provided by customer service

. Developed and adhered to time and cost effective territory management

for assigned counties.

Managed Care Coordinator, [Call Center] Horizon-BCBSNJ, Newark, NJ

1995-1998

. Responded to and reviewed general benefits verbally and/or in writing

with the provider community by giving detailed and descriptive

responses and resolutions. Coordinated written and verbal responses to

executive inquiries or complaints that complied within policy

timeframes and guidelines

COMPUTER SKILLS

Microsoft Office Suite (Word, Excel, Access, Power Point, Exchange and

Outlook), Lotus Notes

EDUCATION

Ramapo College - Communications 1983-1984,

Cittone Institute- Certificate Diploma 1995

Bloomfield College - Business Administration 2004 - 2005

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