Customer Service, Data Analysis, Auditing, Training

Alexis Simpson 313-***-**** ******.********@*****.***

Summary

Skilled professional with a history of providing exemplary and exceptional service in a highly stressful environment. Ability to evaluate and solve difficult problems in a timely manner. Excellent customer service skills; applying a full understanding of client needs balanced with company goals. Effective communication skills to work with both internal departments and external clients. Exhibits a professional and positive work attitude; inspiring favorable outcomes from colleagues and others.

Professional Experience

Provider Resources Inc, Erie, PA-Health Insurance Specialist (July 2023 to Present)

●Analyze documentation and records.

●Makes decisions resolving disputes based on evidence presented by the parties.

●Writing notices clarifying what is expected of the parties and specifying matters of the dispute.

Evolution Gaming, Southfield, MI- Service Support Specialist (May 2023 to June 2024)

●Ensuring game tables are operational without interruptions.

●Providing updates to all concerned parties throughout the duration of major incidents.

●Identifying and resolving all real-time incidents on the gaming floor relating to dealer mistakes and software issues.

BeneSys Inc, Troy, MI- Claims and Quality Analyst (March 2022 to March 2023)

●Researched discrepancies, operational problems and/or other issues.

●Evaluated information surrounding a claim to either approve or deny reimbursement.

●Problem resolution root cause analysis.

●Identified potential contracting/service improvement opportunities.

●Audited processor claims for accuracy and completeness.

Department of Labor and Economic Opportunity- Unemployment Insurance Examiner (October 2020 to March 2022)

●Investigated theft and forgery within customers’ accounts for the Fraud Investigations Unit.

●Identified fraudulent transactions and cancel them from further processing.

●Provided customers with accurate information about claims and benefits.

●Obtained and examined relevant information to assess validity of documentation.

●Handled complex cases which required in-depth data analysis to help provide patterns of fraud by tracking, organizing and analyzing numerous types of evidence.

Blue Cross Blue Shield of Michigan, Detroit, MI -Analyst (December 2017-July 2020)

●Assisted and supported in the planning, coordination, development and implementation of divisional and corporate-wide projects to enhance the overall efficiency of operational procedures, methods, controls and performance.

●Participated in system testing, developed procedures/controls and provided recommendations for the ongoing improvement of the updated process.

●Ensured that departmental processes and procedures complied with Blue Cross Blue Shield Association guidelines.

Customer Service Representative III (October 2013- December 2017)

●Assisted and advised co-workers on handling complicated and problematic customer calls.

●Improved co-workers work productivity by using various coaching techniques and self- demonstration.

Education and Certifications

Master of Science: Public Administration – Central Michigan University, Mt. Pleasant, MI

Bachelor of Science: Applied Sociology – Eastern Michigan University, Ypsilanti, MI

Certification:Lean Six-sigma-Lawrence Technological University

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