Customer Service Quality Assurance

Linde Winton

**** * ***** *** *** #***

Irving, TX 75039

817-***-**** ************@*******.***

SUMMARY OF QUALIFICATIONS

• 25+ years of experience in the Health Insurance Industry including Technical Services, and

System Support, Operations, Customer Service, Training, Policy and Procedure development,

- Medicare and Commercial Insurance SME

Experienced in developing strategies for process improvements and quality control programs

•

for all lines of business including Medicare, Medicaid and Commercial Accounts

Business Analyst at 3 former employers and Director of Technical Services (BAs) for large

•

employer

Experience in the development and delivery of training programs including Compliance,

•

Quality Assurance and Audit.

Experience with writing SQL statements

•

Expert level knowledge of MS Word and PowerPoint, Advanced level knowledge of Excel

•

and Visio, and Intermediate knowledge of Access

MAJOR ACCOMPLISHMENTS

• Implemented corporate wide Quality Assurance programs and Test Plan standards for 3 large

employers

Senior member of the successful startup of a large organization Corporate Training

•

department

Successful startup of Compliance department for a Medicare Advantage account

•

WORK HISTORY

January 2001 – Present HealthSmart Irving Texas

Director - Quality Control / Technical Services / Implementation

• Provide leadership and support to the organization’s Technical Business Analysts, Internal Audit, and

Quality Assurance departments

• Perform needs analysis, develop user requirements and facilitate solutions

• Implement process improvements and monitored success of programs and initiatives

• Analyzes business objectives and develop solutions to issues.

• Gather requirements, identify, analyze, and document business requirements

• Translate business requirements to System/Functional requirements

• Set up test plans and monitor results

• Implement process improvements and monitored success of programs and initiatives

Managed corporate SSAE16 annual audits

•

May 1999 – December 2000 Texas Health Choice Dallas Texas

Y2K Project Manager and Business Analyst

• Managed and assessed organization’s Year 2000 activities.

• Performed needs analysis, develop user requirements and facilitate solutions

• Coordinated implementation of all applications assisting users to perform walk-through and

training as necessary

• Developed strategies for process improvements

• Consulted with clients to assess their systems requirements

Linde Winton (page 2)

1997 – 1999 EDS Plano Texas

Business Analyst and Training Coordinator

Developed strategies for process improvements

•

Consulted with clients to assess their systems requirements

•

Consulted with management on organizational development, team building, and workplace

•

communications

Implemented and trained staff on new Project Data Manager System

•

Coordinated training courses for a staff consisting of 33 Programmers and Business Analysts

•

Produced technical documentation and training material

•

Established departmental documentation standards

•

1986 -1996 Blue Cross Blue Shield, Indianapolis, Indiana

Senior Trainer, Plan Builder, Business Analyst and Provider Relations Representative

• Supervisor Call Center – Medicaid and High Risk Pool

• Created and delivered training presentations for system applications, including new releases

• Produced technical documentation and training materials

• Consulted with clients to assess their systems requirements

• Developed strategies for process improvements

• Coded benefit plans for Managed Care contracts

• Researched and resolved system and reimbursement errors

• Advised providers and internal staff on issues of claim payment criteria

• Assisted contracted providers with contract language and guidelines

Concurrent 2003 – 2005 Company Developer and Owner - LeadershiPledge and

Documented Software Process - Training and Documentation Solutions for Large and

Small Businesses

• LeadershiPledge is a Leadership Skills and Customer Service training company dedicated to developing

successful leaders as well as customer-focused employees with the goal of improving customer satisfaction and

retention and give those in leadership positions the tools necessary to succeed

• Documented Software Processes provides documentation and software training solutions for small businesses.

Contact this candidate