Quality Management

Jerry Abrams

**** ********* **** ****** ***** Lucie West, FL 34986 772-***-**** ***********@*******.***

Quality Assurance & Control, Call Center Operations

Leveraging extensive experience, knowledge and skills to drive excellent QA and client service optimization results.

Over 30 years of experience and success that includes 9 years in a call center operation (with Quality responsibilities within ESI’s Quality Management Department) and 5 years in a PBM environment. Year-over-year record of success in meeting quality, customer satisfaction, business development, and profitability goals. Dual Bachelor’s degree; Six Sigma Green Belt.

Overview

Expertise in identifying critical problem areas and devising action plans that generate substantial improvements.

Apply positive, enthusiastic communications in interactions with management, workforces, and customers.

Exceptional attention to detail while maintaining a focus on strategic, big-picture goals and objectives.

Leadership background includes management of all operational functions within an organization.

Gained solid knowledge of working within a PBM environment, including critical regulatory compliance.

Knowledge & Skill Areas: Quality Monitoring; Client Satisfaction & Retention; Service Improvement; Data Collection & Analysis; Corrective Feedback; Six Sigma Best Practices; Business Process Optimization; Change Management; Internal Auditing; PBM Industry & Pharmacy Operations; QA Inspections; Deadline Commitments; Data Validation; Business Analysis; Strategic & Tactical Planning; SOPs; Staff Training, Mentoring & Coaching

PROFESSIONAL EXPERIENCE

CORRECT CARE SOLUTIONS – 2016-Present

International leader in public healthcare with over 11,000 team members across 38 states.

Process Improvement & Compliance Administrator

Ensure full compliance for the company’s contract with the Department of Children and Families (DCF) as well as complete alignment with the Joint Commission (accreditation agency). Review all policies and provide policy owners with recommendations for updates and improvements. Track laws and regulations affecting facilities requirement.

Design and implement programs, policies, and practices to ensure that all departments are in compliance with TJC accreditation standards, HIPAA regulations, and all applicable federal, state and local statutes. Monitor medical records compliance and complete Steton Audit reports as needed. Analyze indicator reports to track and report trends to executive management in a concise format and a timely manner.

EXPRESS SCRIPTS / UNITED BIO SOURCE / MEDCO HEALTH SOLUTIONS – 2008-2015

United Bio Source and Medco Health Solutions are both owned by Express Scripts.

Quality & Process Improvement Analyst, United Bio Source, 2015

Supported goal of delivering high-quality service and meeting patient/client needs. Presented quality expectations in new hire training and provided detailed recommendations to both supervisors and OPS leadership on coaching (based on trending analysis). Partnered with leaders on adherence to contractual obligations, ad-hoc reporting, client meeting support, and process improvement initiatives among others. Managed quality trending analysis/reporting as well as recommendations for bridge plan management. Oversaw client interfacing for performance guarantees.

Built quality program from the ground up, including the development of training guides and SOPs, quality scorecards, and quality guidelines. Trained 300 agents and all new hires that included all supervisors.

Coached both agents and supervisors to improve understanding of quality guidelines and expectations. Served as a liaison in a successful quality recovery plan.

Created automated evaluation tracking process through link from Excel to SharePoint in order to expedite workflow distribution and ensure client’s contractual compliance. Generated daily reports through Verint, Ceres, and Avaya that provided upper management insight into quality performance.

Ensured delivery of over 1,800 evaluations each month for 545 agents; maintained 100% contractual compliance with completed quality evaluations and call reviews.

QA Representative/Pharmacy Benefits SME, Quality Management Dept., Medco Health Solutions, 2013-2015

Performed full quality control verifications on assigned programs in inbound call center for Medicare Part D (and administrators for Department of Defense health plans), identifying corrective and preventive tasks. Reviewed calls to ensure quality and rated associates via quality guidelines. Coached staff members in need and promoted quality awareness to the entire team. Monitored effectiveness of QA guidelines; brought issues to the attention of upper management.

Requested by Corporate Training to assist with Quality training for new hires and internal transfers. Provide instruction to both groups on quality requirements and best practices, with an emphasis on creating a positive member experience in all interactions. Introduced highly effective training strategies, including role-playing, to achieve results.

Held additional title of Contractual Production Control with the federal government (Department of Defense maintains an annual contract with ESI as its prescription benefit provider). Spot-monitored team members in their outbound calls to DoD beneficiaries to ensure that they educate beneficiaries on all available options with their prescription drug plans. Maintained full adherence to quality guidelines from both ESI and the DoD.

Assisted management in developing and recommending quality control guidelines subsequently implemented for use by all team members.

Received commendations on annual performance evaluation across multiple categories, including Integrity, Mutual Respect, Passion, Collaboration, and Service. Specific comments include:

-“Jerry follows through on all commitments…brings extensive knowledge of Medicare and systems utilization…”

-“Jerry consistently demonstrates enthusiasm and commitment to excellence…has regularly gone above and beyond…”

-“Jerry is considered to be a consistently and actively engaged team member who adds value to decisions and outcomes.”

-“Jerry provides honest and concise feedback with everything he does.”

Prescription Benefit Specialist / Subject Matter Expert, Express Scripts, 2008-2013

Brought on board to increase revenues from outbound Client Benefit calls through interpreting complex plan requirements. Led, developed, and mentored Task Force of 20; served as a Certified Corporate Trainer for numerous client-based programs. Evaluated business process models to define and address areas for improvement. Supported client needs while driving company sales initiatives and goals.

Gained reputation for receiving highest possible client service quality scores and positive client feedback. Additionally signified as one of 5 team members chosen to participate in a key Operational Improvement Task Force.

Recaptured $3 million in potentially lost revenues in 7 months through workflow and process redesign initiatives. Prevented projected loss of $2 million by implementing fail-safe procedures in the event of potential system failures.

Consistently surpassed sales performance metrics by over 45%.

SOLID FINANCING SOLUTIONS – 2000-2009

Director

Held full responsibility for all business growth and performance goals, including operations, strategic planning, and client service management. Led and trained team of 10. Monitored plan to ensure fulfillment of top goals, implementing corrective action as needed. Directed PR, product marketing/ advertising, market research, and business development.

Consistently achieved account closings of $11-15 million annually, including periods with volatile market conditions, through proactive leadership and creative marketing strategies.

Established Key Performance Indicators (KPIs) following thorough analysis of business practices and initiatives. Additionally implemented SOPs for all programs, resulting in significant efficiency and resource allocation gains.

ONONDAGA MUSIC – 1999-2000

Business Manager

Directed entire operations for the largest East Coast retailer within its market, leading a team of 15 in functions ranging from business administration to client services. Scope of accountability included logistics, vendor relations, performance tracking, business development, and operations management. Evaluated success of new process implementations.

Created a dynamic organizational infrastructure wholly responsive to continually changing market conditions and customer needs. Redesigned billing practices that led to recovery of $1.3 million in lost revenues in 9 months.

Increased quality control mechanisms 2x and reduced shrinkage 15% through evaluation of existing business practices and implementation of effective technology solutions.

Achieved national market share of 80% through management of sales/contracting activities and development of solid relationships with schools, religious groups, and civic organizations.

Positioned the business for a profitable sale within 1 year.

PRIOR POSITIONS:

Vice President of Operations, Cotton Textile Services – Led all operations for a company that became the largest commercial linen service in its target markets. Supervised team of 17. Led successful launch of Florida-based operations, growing from zero to 2,000+ customers and $6 million in revenues in 6 years. Increased profits by $500,000 in 1 year.

General Manager, COIT – Managed all regional operations during establishment of multiple offices within the area. Selected and trained all team members, analyzed markets and created business development strategies, and established procedures to ensure sustainable success. Consistently met and exceeded budget objectives.

Vice President of Operations, American Underwriters Group – Oversaw operations and provision of insurance services for high-risk clients. Conceptualized new products, trained team members, and secured govt. approval for international products. Created new business processes for use by over 35,000 employees.

EDUCATION & CREDENTIALS

Bachelor of Science in Business Management, Cum Laude Graduate

Dual Degree in Risk Management and Business Process Analysis – KAPLAN UNIVERSITY

Lean Six Sigma Certified Green Belt – MEDCO HEALTH SOLUTIONS

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