Customer Service Quality Assurance

Confidential User

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

Address: Address Withheld

City: Saco

State: ME

Zip: 04072

Country: USA

Phone: 207-***-****

Skill Level: Management

Salary Range: $70,000

Primary Skills/Experience:

See Resume

Educational Background:

See Resume

Job History / Details:

**SUMMARY**

Dedicated STD claims professional with 19 years of claims experience and 11 years of management experience with proven results in competitive insurance industry. Relied upon for technical expertise for complex claims. Facilitator of positive changes to enhance workflow efficiency and improve quality results. Solid communication and interpersonal skills allow me to build and sustain effective relationships with customers and internal partners. Excellent organizational, customer service, and problem solving skills. Ability to motivate staff, instilling ownership and loyalty.

Additional Competencies Include:

* Customer Service * Risk Management * Complaints Handling

* Hiring, Training & Development * Performance Management * Project Management

**PROFESSIONAL EXPERIENCE**

SUN LIFE FINANCIAL, Portsmouth, NH 2005-Present

Senior Manager, Center for Excellence (2011-Present)

* Responsible for the management/oversight of training, audit, overpayments, and appeals for STD claim organization across 4 locations.

* Manage team of 6 employees in 2 locations (+1 home-based EE reporting to me).

* Responsible for responses to complaints, i.e. Department of Insurance and Better Business Bureau.

* Provide STD management team with monthly audit and appeal reports.

* STD department`s legal and fraud liaison.

* Responsible for the development and communication of the STD department`s policies and procedures.

* Within first 18 months of existence under my leadership, Center of Excellence team accomplished the following:

1. Compiled a new comprehensive 300+ page training binder

2. Improved audit form and process

3. Implemented feedback form on appeals

4. Trained 6 classes of new hires (3 classes in Canada)

5. Designed monthly departmental newsletter, -Soleil Times-

6. Enhanced monthly quality/appeals reporting

7. Provided monthly topical training for examiners based on trend analysis from quality assessment and appeal findings.

* Received Leadership Impact Award (1st Quarter 2012)- nominated by my team.

Manager/Site Leader, STD Claims (2005-2011)

* Provided leadership and management to 8-15 STD examiners.

* Partnered with sales force, brokers/agents, customers, and other functional areas as needed to resolve any work flow or service issues.

* Manages customer concerns/escalations and respond to Department of Insurance complaints.

* Served as subject matter expert for my team and the department on complex claim issues.

* Interviewed and hired new employees.

* Start-up location (Portsmouth, NH) for STD claims in 2005. Catalyst for growth and success of new location- started with 5 examiners and has grown to 20+ examiners. Portsmouth location leads the 3 US locations in productivity and quality.

CORE, INC., Portland, ME 2002-2005

Operations Supervisor, Broadspire Services, Inc. (Formerly the Workability Division of Core, Inc 9/04-1/05)

* Oversaw STD claim unit- managed inventory of team`s claim assignment as well as quality assurance and performance management.

* Served as a liaison with account management in exceeding client expectations.

* Responsible for documenting/communicating policy changes and workflow changes.

Service Leader, Core, Inc, 3/02 to 9/04

* Oversaw 10-14 employees in a customer call center- STD & FMLA absence intake.

* Responsible for hiring, training, performance management of employees.

* Responsible for documenting/communicating training materials and conducting quality assurance audits for call center employees.

* Responsible for daily/monthly tracking of call center statistics.

UNUM, Portland, ME 1991-2002

Policy and Procedures Consultant, Quality Performance Support, 5/01-3/02

* Responsible for the development and communication of policies/procedures for the benefit organizations across sites- Portland, Chattanooga, and Glendale.

* Determined impact of legislative mandates and implemented process changes accordingly.

Senior Internal Auditor, Short Term Disability Benefits (5/98-5/01)

* Responsible for internal audit of STD claims.

* Review of results for trend analysis and training needs.

Disability Benefit Technician & Specialist, Short Term Disability Benefits, (3/94-5/98)

* Responsible for timely adjudication and risk management of STD claims.

* Direct communication with internal/external customers including policyholders, claimants, sales office personnel, brokers, and health care providers.

Customer Service Representative, Customer Service (8/91-3/94)

* Responsible for the accurate system coding of new STD/LTD business for billing and claim systems.

School Districts -Biddeford, Saco, Old Orchard Beach, and Sanford, ME (1990-1998)

Substitute Teacher

* Responsible for carrying out lesson plans and managing classroom during teacher absences. (K-12)

**EDUCATION**

UNIVERSITY OF MAINE, Orono, ME, B.S. in Secondary Education 1989, Honors

**REFERENCES**

Available upon request.

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