Customer Service Manager
Resume:
Darlene Wray
Chesapeake VA ****3
CAREER SUMMARY: I have an extensive history in the customer service field, with a wide variety of situations. I have used my knowledge to implement new processes for more effective use of time and completion of work flow. Through my implementations we were able to keep out service levels above average while meeting the needs of the client, because we dealt daily with state and federal guidelines it was impetative that these goals were achieved. I am able to complete work assignments without supervision and in a timely fashion. My history involved working with the client as well as with the providers of our services.
COMPUTER PROGAMS: Microsoft Word- HCMS - Sanovia - Word Perfect
Microsoft Outlook -CareMark - ART - Client On Line
Fax II- Facets - Amysis
Knowledge and Skills:
Excellent verbal and written skills
Detailed Oriented
Assertive
Self-disciplined and self motivated
Ability to handle upset individuals calmly and effectively
Ability to ask for assistance with member when clinical intervention is needed.
Appreciation of cultural diversity and sensitivity towards targeted population.
Educational background in sociology
Education: Norfolk State University--Norfolk, VA
area of interest included sociology and criminal justice
AMERIGROUP 2007-2014 -Utilization specialist behavorial health
Daily interaction with state representative in regard to authorization of services and procedural guidelines
Familiar with Departmental policies and practices
Functions as a referral source for Members and Providers
Ability to explain the Behavioral Health benefits available to membership in the various markets
Entering authorization for inpatient Behavioral Health
Entering authorization for inpatient Substance/Chemical Abuse
Able to assess member’s referral needs and give appropriate network referrals.
Demonstrate effective customer service skills.
Maintains accuracy for compliance with departmental standards and policies
Interacts with provider community and various departments to resolve issues involving the membership
Assist with activities to ensure membership’s continuity of care
Implemented processes for fax distrubtion
Worked along side case managers for completion of services for members continuation of care
maintain complete confideltialiy
prepare documents for distrubition and workflow
AMERIGROUP 2006 Pharmacy assistant
Enter Authorizations for prescription Medication
Explain to member and provider’s formulary and non formulary items
Telephonic assistance to members and providers
Completely HIPPA qualified
Ability to explain policies and procedures to members
Knowledgeable of state guidelines and regulation
Full understanding of managed care products
Maintained eligibility status
Amerigroup 2005 Member Services Representative
Proactively educate members on services available and complete health assessments for case management
Assist as back up for Inbound Member Services
Familiar with department policies and procedures
Ability to explain policies and procedures to members
Knowledgeable of state guidelines and regulation
Assist with activities to ensure members continuity of care
Full understanding of managed care products
Map Communications
Operator Call Center / Customer Service
Daily interaction with customers via phone and computers
Knowledge of computer program
Multi-line Phones
Customer Service
Internet
Volunteer 1993 – 1996 CARR Family Assn.
Point of contact for families while service members where deployed
Managed Support Meetings
Published monthly newsletters
Communicated with deployed command
Navy Relief Benefit Society
Provided Families with Navy benefits
Helped Families in emergency situations
Provided information for financial assistance
VOLUNTEER:
Habitat for Humanity through Amerigroup
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