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Customer Service Manager

Dallas, Texas, United States
July 16, 2019

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Vivian L Roberts

Arlington, TX *****


Summary of Qualifications

Dynamic focused and results-oriented leader with an exceptional record of success in mentoring and developing resources. Self-starter with excellent communication and people personnel management skills. Seasoned Human Resource professional with tenure years of broad experience in the health and welfare fields; employee benefits as well as the customer service and claims industry. Communicates effectively with all levels of personnel. Outstanding interpersonal and motivational skills. Recognized for HIPAA compliance and maintained personnel information and client information at the highest security level.

Areas of Expertise

Employee Benefits and Plan Provisions Appeals Diversity Coach

Employee Engagement Self-funded Call Center Supervisor

Focused Fully-funded Client Relationship

Training HIPAA Excellent Communicator

Detailed oriented Medicare/Medicaid Office Management

Conflict Resolution DOL Leadership

Professional Experience

Humana Pharmacy October 2016 Present Irving, TX

Customer Service Pharmacy Specialist Agent

Received over 80 inbound calls daily. Responsible for delivering correct and concise information regarding Medicare Part D Members as well as Commercial and Providers.

Advised Licensed Pharmacist and clinical technician on the members pharmacy benefits; placing orders for members; receiving payment for outstanding balances; conducted estimated copays for members which required complete focus and attention detail due to strict Medicare Part D Federal guidelines.

Directed; all calls to necessary and dedicated departments including clinical services and licensed Pharmacist advised; critical details on medication that is taken and the patient next steps.

Mastered the ability to connect with Medicare Members as well as all inbound callers; maximizing best practices by applying maximizer mindset and providing a due diligence attitude. SME to dedicate teams and requested by other Front Line Leaders to assist their agents with their daily roles.

Assisted Front Line Leaders; Team Leader and supported front line agents on metrics, for adherence; after call work, hold time; guidance alerts, staff login time; hold time and end shift time.

Provided immediate feedback for leaders with call concerns of dropped calls received VOC (VOICE OF THE CUSTOMER) and Quality scores; received 100% scored surveys to date as well as 100% quality; received numerous accolades from customers in written form going above and beyond.

VOC scores presented to the Manager of pharmacy; selected by Front Line Leader and Team Lead to assist agents by conducting side by side and coaching opportunities; the ability; to recognize agents that don’t usually speak up by fostering I can do attitude by collaborating and showing leadership skills in a positive forum which is recognize by Leadership.

Able to be recognize by outside vendors as a Leader (COGITO) recognized by COGITO leader as a go to agent for professional; honest and constructive feedback.

American Specialty Health December 2015 to July 2016 Southlake, TX

Claims Supervisor

Monitored and documented individual and team performance; provided timely feedback, coached; counseled; written and delivered performance evaluations as well as PIP’s for adjusters struggling to meet Standard operating processes.

Worked directly Human Resource Leaders as well as direct Claims Mangers on the on boarding; interviewing and termination process.

Supervised front line staff of 23 as well as 15 remote staff located in other states; utilized remote camera as well as blue jeans system to engage off site remote staff in weekly staff meetings.

Responsible for controlling production efficiency, employee motivation, promotion and discipline.

The ability to work in a high stressed environment; able to stay neutral and foster best practices.

Expert in deescalating confrontational situations to maintain a non-hostile environment.

Maintained confidentiality of all employer’s; practitioners, client and other proprietary and sensitive business information; including direct reports salary; pip and personal information; maintained staff time cards on a weekly basis.

Delivered yearly performance reviews; explained metrics and percentage awarded to staff.

Ensured claims compliance with regulatory agencies, accreditation agencies and health plan delegation requirements.

Provided general assistance to department management in the implementation of quality improvement measures associated with audit results from regulatory agencies.

Maintained production and feedback reports. Responsible for maintaining claims inventory delegated work to all staff members daily.

Arranged team engagements monthly; responsible for staff professional development; as well as short term and long-term goals.

Conducted one on one monthly; walking one on one’s fostering wellness; engagement and time for the agent to utilize their resources available to them that allows them to engage in their health and wellbeing.

AON October 2001 to-June 2015 Lincolnshire, IL

Senior Executive Advocate

Instrumental in retaining key Fortune 100 clients; received award recognition 2010,2009 and 2007 for outstanding efforts of client retention.

Handled all client executive escalated concerns as well as general employee’s issues. Worked with various internal and external benefit centers; handled all eligibility issues, responsible for keeping the participant informed of next steps; effectively worked with Doctor offices; obtained all necessary information that allowed for a timely successful resolution

Worked with internal and external client managers; facilitated conference calls in addition to group meetings. Identified trends regarding the employer’s group insurance

Frequent traveled to Benefits Fairs yearly throughout the United States as the employers Benefits Advisor; interfaced with Participants and their families by having one on one meetings; educated employee on their insurance options PPO, HMO, EPO, INDEMENTIY as well as CDHP/HRA and HDHP/HSA

Extensive knowledge of third party processes; worked with all medical insurance companies as well as all prescription vendors, liaison between employer, and Human Resource Generalist

Researched and resolved all member COB regarding Medicare/Medicaid and employer sponsor secondary plans

Worked on various projects introducing and educating various populations on HDHP; CDHP, HSA and HRA; further expanded on federal guidelines regarding tax laws

Role of AT&T Account Manager; partnered with third party vendors and benefit center to resolve escalated executive concerns. Created and submitted AT&T Client summary (excel) monthly

Trained new Advocates on SOP; created the buddy check list and process improvements as well. Guided new hires in building tours and delegated task training to all Senior Advocates

Mentored to new Advocates; Advocacy Certification process; responsible for auditing workflows, scoring and reviewing recorded calls; provided feedback on a weekly basis reviewed workflow tool daily

Delegated escalated manager calls to all Senior Advocates; facilitated presentations to Benefit Centers on Advocacy Role.

Collaborated with leadership suggesting process improvements and SMART goals. Improved delivery with Kaizen and with an in depth SWOT analysis; allowed new tools and software to be implemented and utilized Federal interaction with Medicare/Medicaid on a weekly basis, Dr’s offices; hospital and billing specialist.

Detailed knowledge STD, LTD, FSA whole and limited FSA successfully planned Senior leadership luncheons and yearly engagement events for the Advocacy department. SME for HIPAA; facilitated bi-monthly training regarding PHI (personal health information) created security SOP


DeVry University Bachelors of Science Business Administration; Concentration Human Resources

Computer Skills

Microsoft Word, Excel, PowerPoint, Access, Microsoft Project; ADP, People Soft and CRM

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