Customer Service Staff
Resume:
Vivian High
**** ******* *****, ******, **********
*******@***.***
Experience and Qualifications
Over 20 years of health insurance experience, including private insurance,
and Medicare. Over 15 years of insurance management experience supervising
and managing staff processing written and telephone inquiries, claims, and
claims processing. Well-versed in Medicare rules, regulations and overall
processing center operations. 8 months as a Business Analyst performing
activities related to reengineering processes, retraining staff, improving
performance levels to meet established requirements; developing business
requirements, test plans, testing, and associated document updates.
Scope of Experience: Managed performance of staff handling incoming high
call volumes, claims processing, claims auditor, correction for claims
submitted electronically, eligibility determinations, data correction for
claims that were scanned, and personnel to provide outreach to the
community on Medicare procedures, requirements and guidelines utilizing a
PC and established data base for responses. Managed staff responding to
incoming written correspondence utilizing a PC and established data base
for responses. Reviewed customer satisfaction surveys and evaluated the
data to initiate improvements. Reviewed quality audits and interacted with
agents to provide needed training of staff for improvements. Met hourly,
daily and monthly standards established by external customer owning the
government contract assigned, as well as, all internal customer
requirements. Conducted weekly meetings with staff to provide and receive
information necessary for success in meeting goals. Continually reviewed,
documented and updated all procedures to ensure staff was provided current
information to perform required tasks. Handled all escalated calls,
correspondence and irate walk in customers to resolve problems. Responsible
for handling all interactions with outside vendors to resolve any concerns
or issues related to the handling of claims.
Skills and Abilities
. Strong interpersonal skills
. Excellent oral and written communication skills
. Computer skills to include Microsoft Office and Outlook.
. Strong claims processing experience
. Ability to operate office equipment, including copier and fax machine.
. Ability to get staff to work together for the common department goals
. Effectively responds to the needs and priorities of clients and staff
. Effective with implementing changes
. Strong work ethic
. Effective under pressure, can work independently or as a team player
. Accountable, loyal, punctual, always aware of the bottom line
. Can make decisions and solve problems confidently, based on facts,
common sense, and years of experience.
. Can effectively deal with all levels with an organization.
. Ability to perform tasks with little or no supervision.
. Dedicated to keeping management informed on all critical situations
that could negatively impact expected success in meeting goals.
. Flexible to multi task and meet deadlines.
May 2010- Present
Tria's Cleaning Service
Clean buildings, and assist with identifying new customers by advertising
services offered, and assisting with negotiating contracts.
June 2009-May 2010
Axis Technologies
Business Analyst
Contract Assignment with Hewlett Packard /Government Programs
Developed business requirements for new System Change Requests mandated by
the Centers for Medicare Services (CMS) government entity.
Worked with CMS personnel, system data programmers, and other business
analysts.
Developed test plans and test cases.
Performed testing and documentation updates.
Utilized internal data base (Test Director) for tracking test cases,
requirements and documentation updates.
Utilized SharePoint product for documentation and research.
Resolved problems associated with Change Requests implementation.
January 2008--June 2008
TrailBlazer Health Enterprises, LLC
Business Analyst
Performed reengineering and restructuring of the Medicare Part B Provider
Enrollment department. Contract required a quick turnaround of failing
performance.
All procedures were evaluated and processes changed to correct
deficiencies. Staff was evaluated, performance standards were established,
and basic management strategies for training and staffing were implemented.
Contract was completed successfully and timely.
1990-June 2007
TrailBlazer Health Enterprises, LLC
Actively coordinated and managed all activities associated with customer
service incoming call center, written and walk in inquiries, claims
processing, and Outreach education. During my tenure with the Company, I
held the following positions: Claims processor, Claims Auditor, Specialty
claims coder, Trainer, Unit Leader, Sr. Supervisor and Sr. Manager of
Beneficiary Customer Service. Activities included: developing, preparing
and managing a department budget, interviewing and hiring staff at all
levels, meeting established productivity and quality requirements,
implementing progressive disciplinary structure for staff, coaching/
mentoring staff for improvements, and also managed customer service
operations for multi sites.
Education and Certifications
Business Courses:
. Quality Education System
. Effective Business Writing
. AMA Managing Multi Site
. Quality Service Skills
. Basic Leadership
. ISO Certification
References:
Available upon request
Contact this candidate