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Customer Service Quality Assurance

Location:
Middletown, DE
Salary:
Open for discussion.
Posted:
November 29, 2023

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Resume:

ALBERT PEREZ

*** ********* ***** ********** ******** 19709– ad1jw6@r.postjobfree.com / 267-***-****

Highly motivated and striving, bilingual professional with over 30 years of experience in the Healthcare industry. Proficient with managing multiple teams. Exhibits effective organizational and communication skills. Driven, open to change, and continuously finding ways to enrich leadership skills. Skills and Certifications

• Proficient in Microsoft Word, Excel, PowerPoint

• Strong interpersonal skills

• Leadership Fundamentals: Relationship-Centric

Leadership

• Practicing Fairness as a Leader

• Leadership Foundations: Styles and Models

CAI Computer Aid Inc – Medicaid Product Specialist

• Assist Delawareans with completing and processing the Medicaid application to ensure medical insurance needs are met. Responsible for processing 12 applications a day. Review all pertinent documentation is submitted accordingly.

• Ensure quality assurance is met 100% adhering to departmental and organization standards.

• Follow all policies and procedures when submitting application for approval.

• Adhere to being present for client hearings

Colonial Electric – Lighting Designer – Sales and Marketing – January 2022 – September 2022

• Assist customers with the design and selection lighting fixtures for their commercial and residential lighting projects

• Build relationships with the clients and assist constructing their lighting design o Assist with creating under cabinet and recessed lighting ambiance o The correct application of lighting controls (dimmer switches and dimmable bulbs)

• Assist with creating Landscaping lighting projects

• Smart Home Integration – Bluetooth lighting innovation

• Reading blueprints and creating fixture schedules, specifications and pricing

• Assist with specifying, pricing and ordering custom lamp shades

• Assure customer satisfaction

• Take incoming sales calls with excellent customer service skills Health Partners Plan – Supervisor – Contact Center – February 2016 – July 2018

• Hire Customer Service Representatives (CSRs) and assist in the training process for Medicaid and Medicare programs

• Supervise team of 32 CSRs

• Assure CSRs understood and complied with all call center objectives, performance standards, and policies

• Assist CSRs by answering questions regarding best practices or difficult calls. Assist with handling and resolving escalated/difficult calls, as needed

• Monitoring and evaluating agent performance, providing learning or coaching opportunities, and taking corrective action, if necessary

ALBERT PEREZ

2112 Haven Road Apt. C Wilmington, DE 19809 – ad1jw6@r.postjobfree.com / 267-***-****

• Prepared reports and analyzed data to assist management determine call center goals

• Established close rapport with both internal and external business areas to ensure real time escalation of member facing issues

• Conduct monthly associate feedback sessions and encourage team to meet and/or exceed performance goals

• Measure performance and make promotional and disciplinary decisions

• Daily auditing of calls/Live observance to assure quality customer service was being provided

• Provide monthly analysis and trending of member call types and Complaints UnitedHealth Group Inc. – Internal/External CHIP Sales Consultant – United Health Care Community Plan – August 2012-July 2016

• Responsible for membership growth for the Pennsylvania Children’s Health Insurance Program (CHIP) in Philadelphia, PA

• Manage all counties in the state of Pennsylvania for CHIP membership growth

• Managed top accounts that yielded membership growth. Increased CHIP membership by 1,600 net members a year through direct sales and relationship marketing

• Identified, developed, and evaluated marketing strategy, based on knowledge of establishment objectives, market characteristics, to reach identified target audiences and generated list of prospective clients

• Engaged in public speaking events, presenting UHC products to targeted audiences

• Promoted the food for thought program by presenting at community outreach events, vendor tables and presentations to members and community organizations

• Trained and supervised six sales and marketing representatives

• Achieved significant improvement in productivity and verified completeness and accuracy of the team’s work, computations, records, as well as commission payout

• Performed administrative tasks, such as handling renewal policies, maintaining records and preparing reports of marketing activities for leadership staff, state and federal agencies

• Attended community outreach opportunities that support UHC's business goals and objectives. This includes attending community health fairs, events, conferences, and other related activities UnitedHealth Group Inc. – Retention & Enrollment Eligibility Analyst – United Health Care Community Plan – July 2009-August 2012

• Responsible for increasing CHIP membership and Medicaid retention through adequate screening, referral and enrollment of eligible customers

• Manned two multiline phone (CHIP & Transit) hotlines, responded to inquiries, and assisted with resolving member issues

• Excellent customer service of current and potential members; and prompt problem resolution of member issues

• Prepared renewal packets for Sales & Marketing field representatives

• Receipt and distribution of mail, incoming and outgoing

• Scheduled home visits for field sales force

• Monitored enrollment/retention issues and recommended adjustments in retention strategies as needed to achieve goals

• Worked with print coordinator to order/submit print request for print collateral ALBERT PEREZ

2112 Haven Road Apt. C Wilmington, DE 19809 – ad1jw6@r.postjobfree.com / 267-***-****

• Populated Membership growth, Sales Production and Member Retention reports and sales producers commission payouts for upper management

• Worked closely with and supported sales leadership, providers, member services and other areas to ensure member satisfaction

Keystone Mercy Health Plan – Supervisor – Care Coordination/Rapid Response Team - May 2007 – February 2009

• Responsible to provide daily oversight of the Care Coordination/Rapid Response unit

• Provide clinical direction, organization, and monitoring of all Care Coordination services

• Responsible for direct supervisory oversight of team conducting case management screenings, care coordination, case management, and other supportive functions to promote best healthcare outcomes to the consumer

• Assist with handling and resolving escalated/difficult calls, as needed

• Conduct monthly associate feedback sessions and encourage team to meet and/or exceed performance goals

• Measure performance and make promotional and disciplinary decisions

• Prepared reports and analyzed data to assure departmental goals were being met

• Monitor and live observe calls to assure quality service was being provided

• Facilitate monthly calibration sessions meetings with team to review audit findings, trends and mutual collaboration on training opportunities

• Attend and/or conduct business meetings to discuss error trends and recommendations for improvement, as needed

EDUCATION

Reading High School, Reading Pa Reading Area Community College RELEVANT WORK EXPERIENCE

CONTACT CENTER SUPERVISOR Keystone Mercy Health Plan 2003 - 2007 QUALITY AUDITING SPECIALIST III Keystone Mercy Health Plan 1998 - 2003 CUSTOMER SERVICE ASSOCIATE III – ENROLLMENT ASSOCIATE Keystone Mercy Health Plan 1996 - 1998



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