Customer Service Quality Management

Janet Smith

East Cleveland, OH ***** 216-***-****

***************@*****.*** https://www.linkedin.com/in/janetpsmith/

Insurance Support Strategic Planning & Implementation Sales Management

Forward-thinking, innovative professional with 20+ years of experience delivering cutting-edge business improvement solutions through lean manufacturing and total quality management tools in global companies. Demonstrated record of a repeat success in assessing customer needs, making sure targets are attained, assigning tasks, and implementing new strategies. Talented executive skilled at recruiting and maintaining high-performance employees and teams of experts. Demonstrated high quality of knowledge, strong leadership, and collaboration skills while directing projects that improve efficiency, and meet deadlines and budget requirements.

Significant Accomplishments:

Served as Leader of Insurance Support and Sales with the lowest score. Received recognition within 3-months for support of the sales team.

Earned recognition for demonstrating exceptional performance in several areas of key performance indicators specific to the department.

Significantly increased customer base by obtaining a strong reputation for providing excellent customer relations.

established a reputation as one of the three top copay collectors in the department for over four years.

established a reputation for providing direction and coaching to employees on a daily basis.

Brought backlog of over 90 prescriptions to the current date in under three months.

Kept the Sales Support team under 10% of root causes for denials.

Core Competence

Policies & Administration

Network Management

Healthcare Management

Policy Development

Strategy & Negotiation

Business Administration

Network Performance

Sales Education

Healthcare Administration

Operations

Credentialing

Strategic Direction

Quality Management

Project Management

Time Management

Problem Solving

Policy & Procedures

Resource Allocation

Customer Service

Strategic Planning & Implementation

Problem Resolution

Innovative Sales & Marketing

Product & Service Promotion

Client Acquisition & Retention

Training & Leadership

Consultative Selling

Regulatory Compliance

Business Acumen

Sales Orientation

Leadership & Time Management

Analytical Thinking

Care Management

Career History

GOLDEN STANDARD ENTERPRISE, 2022 to present

CLIENT SUCCESS MANAGER, CLEVELAND, OH

Management of assigned accounts

Maintaining client relationships as a Client Success Manager

Providing quality assurance oversight

Proactively seeking new sales opportunities to grow business

Networking with industry affiliations

Training and support of staff

Manage the schedule of staff

Developing existing clients for expanded sales opportunities

Provide hands-on cleaning services, during the initial launch phase of the new contract

SELMANCO, 2021 to present

ENROLLMENT SPECIALIST, CLEVELAND, OH

Maintained stable and efficient workflow that allows faster turnaround time for each client account within less than three months of employment

Responsible for updating members’ information for each Tri-Care supplement account.

Janet Smith

p.2

Career History (cont.)

Correspond with insurance companies regarding discrepancies in members’ accounts.

Promptly resolve time-sensitive delays in a professional manner to provide efficient customer service.

Proven ability to learn and execute the assigned task quickly and proficiently.

NATIONAL BIOLOGICAL CORPORATION, 2020 to 2020

INSURANCE SUPPORT MANAGER, Beachwood, OH

Created the first written procedure guide - information input, insurance benefit checking, missing information, pre-authorization, and claims processing.

Prepared staff for transition due to the COVID19 Pandemic without the department falling behind on set tasks.

Accomplished sales support results by communicating job expectations, planning, monitoring, and appraising job results.

Maintained workflow - Monitored processes, and initiated and fostered a spirit of teamwork in the company.

Created an environment with quick turnaround time and created cross-training guide to prepare staff for new upcoming performance reviews.

Worked closely with finance department - analyzed insurance company’s explanation of benefits in comparison to company Accounts Receivable system and manage weekly report.

Communicate with customers regarding, billing, purchasing, negotiating, contracts, payment, and insurance issues.

Communicate with insurance companies to settlement proposals, contracts, and payments.

CLEVELAND CLINIC FOUNDATION, 2013 to 2020

PATIENT SERVICES SPECIALIST II, East Cleveland, OH

Trained staff regarding the registration process while preventing payment denials through auditing.

Expertly determined and addressed issues in relation to insurance company authorization requirements with a focus on health insurance coordination of benefits.

Handled the processing of financial assistance applications for patients without insurance to the appropriate charity program offered through the Cleveland Clinic’s Hospital Care Assurance Program (HCAP) to ensure proper provider care.

Completed extensive training in other areas and locations that utilize the EPIC host system to support short-staffed teams.

Maintained active involvement in various engagement projects in alignment with the Cleveland Clinic Enterprise values.

Promptly resolved time-sensitive delays in a professional manner to provide efficient customer service.

EDUCATION TECHNICAL SKILLS

Bachelor of Arts in Business Management, Hiram University, Hiram, OH; Graduated cum laude (GPA:3.55); 2019

Departmental Honors in Business Management for Academic Achievement in Accounting, Economics, and Management

Associate of Applied Business Major in Business Management, Cuyahoga Community College, Cleveland, OH, 2005

Display technical proficiency with EPIC Host System, Kareo, Act, ADTR, Passport

Microsoft Office Suite (Work, PowerPoint, and Outlook)

Contact this candidate