Customer Service Manager

Anita Lofton

**** ****** **, ********** **. *****

Home 916-***-**** mobile 619-***-****

*********@*****.***

• Personal commitment to integrity, calibration and flexibility

• Cultivates relationship driven accounts that are based on profit, potential profit

and name brand recognition.

• Develops and executes customized client strategies that enable the organization

to meet company goals, increase market share and maximize product servicing.

• Leads and work productively as part of a high performance team with proven

ability to create a competitive advantage with the customer.

• Effective and productive organization, interpersonal, analytical, negotiation and

network skills, combined with a strong personal presence.

• Specialize expertise in Group Benefits including Managed Care, Medicare,

Workplace Wellness and Provider Engagement

Humana

Provider Engagement Manager

Present-2013

• Through specialized knowledge, health management experience, education and

research, providers and medical groups are provided resources to address

issues and take appropriate action to move the metrics and adhere to CMS

compliance program and policies as it pertains to HEDIAS, MRA, STARS & Part

D.

• Serve as focal point regarding financial settlement, delegation, claims

adjudication, and funding that drive positive business results for risk groups.

• Manage and deliver reporting and analysis on profitability and performance for

internal and external entities on risk groups.

• Perform and/or collaborate with Finance on analysis of trend issues, cost savings

opportunities, utilization patterns, and other analysis as needed on risk groups

• Make recommendations to market leadership through detailed

analysis/consideration of financial and operational implications to Humana and

risk groups

• Successfully facilitate/implement various initiatives with groups (HEDIS, MRA,

STARS, etc.)

MGK Insurance,

Senior VP Of Benefits 2013-

2009

• Successfully positioned company as a competent leader in the small group

employer arena.

• Gained trust of employers resulting in invitations to provide proposals for group

benefit plans for their employees..

• Offered solutions that gave employers the advantage of cost control while

achieving a higher level of employee retention.

• Facilitate open enrollment meeting for employees and became the liaison

between the employer and the health plan.

• Sold diversified products including voluntary products i.e. Cancer Products,

Critical Care, Accident, etc.

Health Net Of California

Senior Account Manager -National Accounts 2009-2001

• Negotiated renewals and managed over $3 billion book of business for retention

in group growth and customer satisfaction.

• Educated large client groups on evidence base practice model i.e. Health Dialog-

Care Management, Shared Decision Making and Wellness Coaching, which

enabled the client to focus on chronic and preference sensitive condition within

their organization and create programs that empower employees as well as

generate R.O.I.

• Utilized strategic business plans to develop partnerships with key brokers and

consultants to increase loyalty to the Health Net brand and promote full product

line.

• Advised clients and brokers on issues related to funding alternatives, state

legislation, plan design modification and general administration.

• Worked closely with internal departments to enhance customer service to

members and group contacts.

• Consistently met and exceeded retention /profitability goals.

Education

• AHIP Certified 2009-2013

• Heald Business College, San Francisco

• UCLA Extension

• Life & Disability & Fire & Casualty License

•

Recognition

• Certificate of Recognition-Out Standing Leadership-State Senator Joel Anderson

2011

• National Association of Negro Women, Business Association Award 2010

• National Association of Professional Woman 2009-2010

• Founder- Central San Diego Black Chamber Of Commerce 2009

• UNCF Executive Board Member 2009-11

100% Retention, Top Producer, 100% Club, Account Manager of the Year, Grand Prize

Winner, First Prize Winner, Service is Golden Award, Sale Contest winner for Specialty

Products.

Computer Skills: Windows, Word, Excel, Lotus Notes, Outlook and PowerPoint, File

Maker Pro, Micro-Soft Publisher.

Contact this candidate