Customer Service Project Management

MELISSA RUTHERFORD

Nashville TN 615-***-**** *******************@*****.***

Executive Profile Summary

Dynamic and goal driven professional with experience in the insurance healthcare sector. Proven expertise in navigating complex regulatory environments, optimizing operational workflows, and delivering strategic solutions to enhance organizational efficiency and client satisfaction. Skilled in training and mentoring teams, leveraging deep knowledge of insurance policies, claims processing, and compliance standards to drive superior performance. Adept at fostering collaborative relationships across multidisciplinary teams and stakeholders to achieve business objectives. Seeking to leverage comprehensive industry knowledge and leadership abilities to contribute to the continued success of a forward-thinking healthcare organization.

Core Competencies

Proficient in Microsoft Office

Critical Thinking

Time Management

Analytical

Subject Matter Expert

Problem Solving

Communication

Project Management

Attention to Detail

Training Management

Customer Relations

Technical Proficiency

Quality Assurance

Project Management

Adaptability

Leadership

Professional Experience

Central Support Operations Coordinator (team SME) 01/2019 to Current

Navihealth-(UnitedHealth Group) Nashville, TN

Authorization Processing: Manage the authorization wizard process, handling new authorizations, updates, and related documentation such as NOMNC and additional clinical information.

Communication Management: Handles both inbound and outbound communications, including new authorization requests, PVN approval notifications, and clinical requests via phone and fax.

Training and Mentoring: Conducts comprehensive training sessions for employees on various tasks including BCBSM PVN/Auth wizard operations, Fide/IDN procedures, clinical requests handling, and MDR review processes, encompassing email protocols and Optum submission guidelines.

Documentation and Uploads: Manage MDS uploads, including email and fax discharge documents, ensuring accurate and timely updates in the system.

Provider and Member Support: Conduct outbound calls to confirm ordering physicians, requested clinical documents, and addressed Peer-to-Peer calls. Respond to provider emails regarding authorization status.

Data Verification and System Updates: Verify MD addresses in Salesforce and responded to authorization status inquiries in ICUE, maintaining data accuracy and providing timely updates.

Pilot Programs and Member Outreach: Participate in pilot programs during the pandemic to provide additional resources to members, including wellness calls to offer support with food, medication, community resources, and human connection.

Epayable Customer Service Specialist 08/2016 to 01/2019

North America Administrators Nashville, TN

Customer Support: Provided exceptional customer service to clients, addressing inquiries and resolving issues related to epayable services promptly and efficiently.

Payment Processing: Managed the processing of electronic payments, ensuring accuracy and timeliness in transactions to maintain client satisfaction and trust.

Issue Resolution: Investigated and resolved payment discrepancies, working closely with clients and internal teams to ensure smooth and accurate payment processing.

Account Management: Assisted in managing client accounts, updating payment information, and ensuring that all client data was accurate and up to date.

System Navigation: Utilized various payment processing systems and software to track and process payments, ensuring compliance with company policies and industry regulations.

Reporting: Generated and analyzed reports on payment activities, identifying trends and areas for improvement to enhance service delivery and operational efficiency.

Collaboration: Worked with cross-functional teams, including finance, IT, and customer service, to streamline processes and improve overall client experience.

Legal Specialist 10/2014 to 08/2016

Young Williams Child Support Services Nashville, TN

Legal Document Preparation: Drafted, reviewed, and finalized a variety of legal documents including contracts, agreements, pleadings, and correspondence, ensuring accuracy and compliance with relevant laws and regulations.

Case Management: Managed and organized case files, including maintaining schedules, tracking deadlines, and ensuring timely submission of court filings and other legal documents.

Research and Analysis: Conducted comprehensive legal research on case law, statutes, regulations, and legal articles to support case preparation and strategy development.

Client Support: Provided direct support to clients by addressing inquiries, gathering information, and explaining legal procedures and documents in an understandable manner.

Liaison with Legal Teams: Coordinated with attorneys, paralegals, and other legal professionals to facilitate case progression and ensure seamless communication across teams.

Compliance Monitoring: Monitored changes in relevant laws and regulations, ensuring that company policies and procedures remained in compliance with legal standards.

Administrative Support: Assisted with various administrative tasks such as scheduling meetings, managing calendars, and organizing legal documentation to support the efficient operation of the legal department.

Assistant Manager 12/2012 to 10/2014

Speedy Cash Nashville, TN

Operational Leadership: Assisted in the daily operations of a high-volume financial services center, ensuring adherence to company policies and procedures.

Customer Service Excellence: Provided exceptional customer service, addressing inquiries, resolving escalated issues, and ensuring a positive customer experience.

Team Supervision and Training: Supervised and trained a team of customer service representatives, ensuring productivity, adherence to operational standards, and continuous development.

Financial Transactions: Managed financial transactions including cash handling, deposits, withdrawals, and loan processing, ensuring accuracy and compliance with regulatory requirements.

Sales and Performance Management: Contributed to achieving sales targets through effective sales strategies, promotions, and customer retention initiatives.

Compliance and Risk Management: Ensured compliance with regulatory guidelines and company policies related to financial services, minimizing risk and maintaining a secure operating environment.

Administrative Support: Assisted in administrative tasks such as scheduling, inventory management, and maintaining records to support efficient store operations.

Education and Training

Associates Degree: Criminal Justice

Daymar Institute Clarksville, TN

Diploma: Real Estate Broker

Success Real Estate School Nashville, TN

Accomplishments

Recognized with three diamond awards for Exceptional Performance.

Honored with two diamond awards for Outstanding Leadership.

Received a diamond award for Building and Maintaining Strong Relationships.

Contact this candidate