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Customer Service Data

Hyattsville, Maryland, United States
September 18, 2019

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**** ******** ****** ***********, ** 20784

C: 301-***-**** O: 240-***-**** E:

Forward-thinking professional with demonstrated experience in health insurance care administration, skills and training in computer information systems with an outstanding record of accomplishments providing solutions that exceed expectations. Strategy architect in the development of innovative solutions to streamline processes and capitalize on organizational growth opportunities. Skilled at converting complex subject matters into easily understood material with an innate ability to lead teams, analyze data, identify risks, determine objectives, and develop strategies. Good problem-solving and communication skills, both verbal and written. Ability to sustain work pressure in an effective way. Well organized, detail-oriented, positive attitude, high degree of precision, flexible arrival and departure times, and an excellent team player. Relevant skills include:

Data Management Business Analysis Quality Assurance Change Management Policy Development Error Management Team Leadership Quality Assurance


KAISER PERMANENTE, Rockville, MD 1997 – Present

Data Management Intermediate Business Analyst Health Plan Representative Training Coordinator Office Manager/Marketing & Sales Support Specialist

Provide expert level analytics and business process development guidance to the Region Team. Serve as subject matter expert at the regional and national level on various projects. Study, analyze, and develop ways to improve the accuracy, adequacy, timeliness and validity of data. Leverage broad competencies in technology, electronic data interchange (EDI), error management, business validation, user acceptance testing (UAT), quality improvement and change.

Key Achievements:

Project Management: Plans and coordinates projects and assigned activities. Demonstrates effective use of Time Management for assigned activities.

Meta Data Repository: Maintains content of current information repository. Populates information repository and deploys updates. Performs quality assurance and consistency checking under guidance of higher-level resources.

Data Design (logical): Assists in the development of detailed project data models in conjunction with clients and staff. Coordinates publication/deployment of these models.

Data Development (physical): Assists in the physical design, testing, and implementation of the organization’s databases’

Database Performance: Produces performance reports that assist with capacity planning, database modeling, forecasting and tuning. Develops performance evaluation report formats. Supports lower level resources as work relates to performing tasks. Works under the direction of higher-level resources.

Communications: Articulates own work products to project team.

Technology Evaluation: Gathers data and presents data to project team.

Methodologies and Standards: Assists in the development of new methodologies/standards for supporting information management.

Database Management and Support Tools: Assists in implementing, configuring and maintaining database management and support tools under direction of higher-level resources.

Client Consulting: Assists higher level resources in consulting with clients and development areas in the design and implementation of simple, well-defined projects. Consults with clients to determine database requirements.

Training/Mentoring: Provides coaching to staff on tools, systems procedures and policies. Ensures knowledge transfer to lower level resources in performing specific documented tasks or procedures.

Data Transformation: Develops, test and implements simple extract and load routines with simple transformations.

Database Maintenance: Provides first level problem diagnosis and resolution using a standardized approach. Corrects/fixes basic database problems independently. Provides basic preventive maintenance. Directs lower level resources in performing basic tasks. Escalates as necessary and provided problem resolutions.

Provide ongoing leadership and guidance to the Mid-Atlantic States’ commercial and self-funding errors.

Documents Electronic Data Interchange transaction and data issues and resolution.

Resolves various errors resulting from the electronic data integration of 834 and Keel spreadsheet.

Conduct business validation and UAT, gap analysis of commercial enrollment front-end processing, implements small test of change, eliminating redundancy, and promoting timeliness an efficiency.

Compiles, calculates, prepares and distributes ad-hoc and standardized reports for Membership Administration resources and external departments.

Knowledge of application of standard principles, theories and techniques.

Use professional concepts and company policies and procedures to solve a wide range of difficult problems in imaginative and practical ways.

Develop queries to extract data for analysis and interpretation for consumption by project teams to inform decision-making throughout the lifecycle of a project, from inception through the control phase.

Develop and implement automated tools to improve efficiency and quality of benefit configuration build and validation.

Analysis/evaluation of business cases, and provide client support during system development.

Acts as subject matter expect on inquiries related to the commercial lines of business and ID cards.

Coordinate ID card management including requirements gathering, change management, implementations, issue resolution and vendor management.

Develop enhanced ID card policies and procedures.

Routine monitoring of ID cards operational changes involving regulatory compliance, ordering and accuracy.

Works with Information Technology, Compliance, Marketing Communications and ID card vendor to implement processes and procedures for new ID card.

Responsibilities impact the achievement of team or department objectives to provide the members ID cards on a timely manner.

Participates in the analysis of client business processes and functional requirements and in the preparation of appropriate documentation to communicate and validate the information.

Review & provides input into RFPs.

Analyzes data and provides clear, concise reports to the Call Center Management Team regarding quality and productivity issues related to customer service representatives for ID cards.

Experienced in health care customer service by responding with empathy to complaints and concerns from members concerning Health Plan benefits, account status, payment history and medical services.

Initiate contact with the appropriate Health Plan, Medical Group and facility personnel to obtain information relevant to the concern or inquiry, as needed. Evaluate training needs of internal customers, external vendors, and environments manager to determine equipment needs and software installations in classrooms.

Participate in implementation planning meetings for large-scale core and project training events. Develop, track and report on detailed scheduling plans to support implementation activities.

Work with managers and supervisors to determine the appropriate classes for their staff.

Manage the department’s annual budget and ensure that activities are performed within budget.

Serve as a key member for the Sales and Marketing department to develop new products and services.

Monitor the customer feedback and seek ways to soften the internal/external customers’ needs.

Create customized reports to support purchaser needs and account strategy.


Cytotechnologist/Assistant Computer Clerk Finance Specialist

Performed daily entry of cytology diagnostic results ensuring continuous flow of work under time-sensitive deadlines, involving several hundred patients.

Compiled cases for cytology-histology correlation; labeled slides for processing and filing.

Maintained correlation logs and documentation.

Scheduled patients and provided administrative support to the orthopedic clinic.

Assisted other technologists as needed.

Monitored accounts and documentation to ensure funds were available for requested actions being charged to appropriate accounts and figures were accurately recorded.

Researched and extracted transaction data, verified totals, clarified and corrected discrepancies.

Maintained ledgers and related documentation to record funds for project obligations.

Substituted in other position as needed.


CHEM CLEAN Import & Export Coordinator



Bachelor of Science, Strayer University, Computer Information Systems

International Foundation for Protection Officers - Security Supervisor Program Certification

Certified in Security Supervision and Management


Army Commendation Medal

Army Service Ribbon

Good Conduct Medal

National Defense Service Medal

Letter of Appreciation for Job Performance

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