Customer Service Administrative Assistant
Resume:
Tonya S. McCallum, M.A.
***** ***** ****** *******, ** 48221 ~ 313-***-**** ~
************@*****.***
PROFESSIONAL EXPERIENCE
Catalyst Healthcare Group, Flint, MI
Blue Cross Blue Shield of Michigan
Health Plan Advisor
Fall 2012
. Assisted the Medicare "Over 65" Team, during the annual open
enrollment period, with incoming calls/enrollments into one of the
Medicare Advantage, Medigap, and/or PDP plans offered through Blue
Cross Blue Shield and Blue Care Network of Michigan. This was a high-
volume, quantity and quality rated position. Other duties included
benefit interpretation and basic administrative duties as assigned.
4 D Pharmacy Management, Troy, MI
Administrative Assistant, Managed Care
2011- 2012
. Assisted the Managed Care Team with daily support of operations
including, but not limited to, faxing, copying, emailing, mass-
mailing, appointment scheduling, meeting planning, project
implementations, prior authorizations, marketing events and other
related duties as were assigned.
Midwest Health Plan. Dearborn, MI
Supervisor, Enrollment Services Department
2009 - 2010
. Evaluated and reported to the department head, all routine
statistical data including, Enrollment reporting, encounters and
complaints.
. Planned and conducted regularly-scheduled staff meetings.
. Aided in the planning and implementation of enrollment-related
surveys.
. Served as liaison to the other departments, assisted with
enrollment issues and resolution of membership eligibility
problems.
. Handled enrollment/eligibility issues not resolvable at subordinate
staff level.
. Maintained records and reported on membership & revenue growth
and/or loss, complaints and results obtained
. Functioned as a resource on enrollment/eligibility related matters
to primarily the customer service staff, employer groups,
pharmacies, and other various company departments (i.e., Claims,
Provider Services, Health Services, etc.).
. Assisted the Marketing Department with open enrollments,
presentations and account support.
. Completed routine Customer Service Department reports on a weekly,
monthly and quarterly basis, as assigned
. Completed routine Enrollment Services Department reports on a
weekly, monthly and quarterly basis, as assigned.
. Received, records, and prepared enrollment requests received from
the Customer Service Department.
. Provided assistance in developing new projects.
. Interacted, both verbally and in writing, with department staff,
employer groups, members and providers.
Health Alliance Plan, Detroit, MI
Reconciliation Specialist, Membership & Billing Department
2004 - 2008
. Reconciled commercial group accounts in reference to what the company
billed vs. what the group paid.
. Prepared manual excel spreadsheets which documented discrepancies for
the group to review and respond.
. Entered information into HAP's Auto Reconciliation System so that it
would be in alignment with the manually prepared Excel spreadsheets.
. Communicated verbally, written and via fax, when needed, with group in
effort of reconciling accounts.
. Prepared debit/credit memos to be processed interdepartmental in
effort of clearing out unresolved discrepancies.
OTHER WORK HISTORY
Health Alliance Plan, Detroit, MI
Accounting Assistant 2002 - 2004
Health Alliance Plan, Detroit, MI
Government Program Specialist 2000 - 2002
Selectcare Inc., Troy, MI
Medicaid Program Assistant 1999 - 2000
Customer Care Rep II 1997 - 1999
EDUCATION
Master of Arts, Management and Organizational Development
2009, Spring Arbor University, Spring Arbor, MI
Bachelor of Arts, Business Management and Organizational Development
2006, Spring Arbor University, Spring Arbor, MI
CERTIFICATIONS AND MEMBERSHIPS
Government Program Assistant Training Certification Course, 2000
Reconciliation Specialist Training Certification, 2004
Leadership Effectiveness, 2009
Leaders are Made Not Born, 2009
Managing Diversity, 2011
TECHNICALSKILLS
Proficient in Microsoft Office with emphasis on Word, Excel, PowerPoint,
PeopleSoft & Blogging
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