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Customer Service Manager

Location:
York, South Carolina, 29745, United States
Posted:
May 29, 2010

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

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

York, SC *****

Tel: 704-***-****

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

Summary

Skilled in multi-tasking and maintaining focus on the long term goals

established by the organization. Dedicated to working efficiently and

accurately under pressure while maintaining a positive outlook regarding

the Company's established values and practices.

Career History

TRANSAMERICA REINSURANCE

Level II International Operations Analyst August 2009-

present

Responsibilities include reviewing and posting monthly/quarterly premium

statements for multiple international clients (Korea, Japan, Latin

American, etc) which adds a complexity to the general ledger posting

process due to the multiple currency exchange rates and "home grown"

systems which enable this workflow to exist. This process also includes

communicating with multiple regions, time zones, and cultures to ensure

accuracy in the reporting of premium data and claims in compliance with the

treaty provisions. Current key goals include transitioning existing paper

reporting to an electronic data format that can utilized to assist with the

experience studies and enable the overall statement process to be more

effective. This includes coordinating the assistance of data management and

IT teams to ensure all results are met for value of new business.

Claims Analyst Team Lead February 2008 - August 2008

Assisted Manager with day to day operational functions to ensure that all

results were met and maintained. Trained as a back-up to the Manager to

act in her absence regarding reports. Facilitated multiple in house

training (Specifically: A Lunch and Learn on selecting the correct Causes

of Death and WIP release training which included a step-by-step guide to

processing claims.) Continued collecting SOX documents for the team, team

audits, processing complex claims, and supporting the analysts as needed.

Senior Claims Analyst July 2006 -February 2008

Continued analyzing/processing reinsured life claims with more focus on the

more complex clients. Began collecting SOX documents for the team, team

audits, and supporting other analysts when their workload was heavy or they

were out of the office. Facilitated Beyond the Basics for Claims.

Claims Analyst April 2006 - July 2006

Analyze/process reinsured life claims with accuracy and timeliness. The

policies are reinsured and retro ceded through multiple companies both in

the US and across multiply continents.

MUTUAL OF OMAHA, Gastonia, NC 2003 - 2005

Technical Unit Claims Manager

Supervised a team of 22 Claims Analyst/Specialists and the office's

trainer. The analysts and specialist handled appeals, adjustments,

preauthorizations, returned drafts, refunds, and worked directly with new

examiner trainees. Monitored results through monthly MBO's (Managed

Business Objectives). The office trainer was responsible for all new hire

training classes in addition to "in house" refresher trainings as

determined by quality results. The responsibilities of the Technical Unit

Claims Supervisor also included completing payroll, daily work

distribution, inventory management, coordinating support when necessary

with Sister offices in South Dakota and Oklahoma, bi-annual and annual

appraisals, continual staffing analysis, and maintaining Gallup survey

results within the 50th percentile.

Responsible for revising existing technical production standards which

resulted in a staffing reduction saving approximately $150,000 in

salary. This project began in July, 2005 and the new standards were

implemented in October, 2005.

MUTUAL OF OMAHA, Gastonia, NC 1996 - 2003

Production Claims Unit Supervisor

Supervised a team of 22 Claims Examiners ranging in experience from new

hires to seasoned associates. These examiners were responsible for the

accurate and timely processing of medical health claims which were

monitored through monthly MBO's. The responsibilities of this position

also included completing payroll, daily work distribution, inventory

management, dictating and delivering bi-annual and annual appraisals,

continual staffing analysis, and maintaining Gallup survey results within

the 50th percentile.

In January, 2003, the Company transitioned to a Trizetto computer

system (Facets) which resulted in a reduction of each team's size by

approximately 5 examiners. As the first team in the office to process

claims on this system, accuracy and timely handling of claims did not

suffer. In addition, interaction between my team and the IS (system)

team was critical to ensure that the OBRA (Omnibus Budget

Reconciliation Act of 1993) Law was applied appropriately to the

applicable claims.

MUTUAL OF OMAHA, Gastonia, NC 1995 - 1996

Technical Claims Analyst

Responsibilities included reviewing first level appeals, preauthorization

requests, loss control reviews, claim adjustments, returned drafts,

refunds, and working directly with the newest examiners.

MUTUAL OF OMAHA, Gastonia, NC 1994 - 1995

Customer Service Representative

Responsibilities included answering calls from members and providers

regarding benefits; eligibility; specific claim related inquiries; and

initiating preauthorization requests, appeals, and claims adjustments.

MUTUAL OF OMAHA, Gastonia, NC 1993 - 1994

Junior Claims Examiner

Responsibilities included accurately and timely processing paper medical

and hospital claims submitted via HICFA 1500 and UB92 forms.

Education

Gaston College, Registered Nursing Program (9 credit hours from completion)

Professional Development

Transamerica's Team Leader Development Program (November 2007)

Dean Vaughan's Medical Terminology

Quality Management (QWG) certification course

Service Plus (seven week Customer Service certification course)

Interact

Achieve Global courses: The Service Difference (TSD); Your Role in

Quality; Managing Extraordinary Service; Moving the Organization Forward:

Defining Your Team's Contribution, Resolving Conflicts within Your Team,

Gaining Commitment to Preset Goals. The Principles of Genuine Leadership

Manager's Version: Giving Recognition, Handling Emotions Under Pressure,

Correcting Performance Problems, Developing Others, Providing Constructive

Feedback, Proactive Listening.

E-learning and internal courses provided by Transamerica and Mutual of

Omaha: Coordination of Benefits, quarterly fraud awareness, managing

without Interference, Managing within the Law, annual Harassment

Prevention, Behavioral Interviewing, Your Role in Quality, DISC profile.

Seminars: Franklin Covey's Focus

Special Skills: Microsoft Office (excel, word, power point) and Facets

(Trizetto developed claims paying system). Transamerica created and

maintained systems include: RIAS (general ledger system), CARES (claims

paying system), PODS (system used to "house" premium and eligibility

information), TRIAD (foreign currency ledger), LiveLink and Keyfile

(electronic scanning systems used to store treaties-policies and data).



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