Tarsha Nelson

**** *. ******* ***.

Tampa, FL ***10

813-***-**** (Cell)

adqmng@r.postjobfree.com

KEY SKILLS:

Health, Life Insurance, Disability (Short and Long Term)

Excel, Word, Vizio, Power Point, BPI Process Management Project, 834 File Feed

Quality Assurance Training and Auditing/ SME

Quality Assurance Testing/ QA Quality Center/Defect Initiation

Project Tracking

Cisco Communications

WEB Gateway Tool

EDI 834/820 Audits

PROFESSIONAL EXPERIENCE:

Health Plan Services

8/2014- Present

Account Resolution Specialist Mkt Place

Handles one or more business units; Billing and Enrollment

Handle escalated calls for one or more business units;

Review and sign-off on all exceptions for one or more business units;

Respond to written inquiries, grievances and/or appeals as needed;

Work closely with management and the Voice of the Customer Unit to define problems and facilitate Process Improvement.

Supports the objectives of the team, department and corporation.

Takes on special projects as requested;

Regular attendance in order to meet business objectives

Submit IMS tickets/ Maintains schedule adherence of 97%

Support iGate/CapGemini

May be accountable for work of others.

Minimal supervision required.

Tasks in direct support of the department's primary activities for which the incumbent has the direct responsibility for recommendations that will result in action with minimal review.

2015 BPI Billing & Enrollment Project

Health Plan Services

June 2013 – August 2014 (G2E)

Associate Technical Business Analyst (Assisting as QA Tester in IT)

Execute any and all tasks given via Team Leads

Create and execute user stories for several PSCR’s providing necessary resolutions.

Test of the implicit requirements

Test of the system in SIT and UAT using different types of tests and tools

834 Feeds.

Test user stories using various software; CSR, TAS, MAINFRAME

Resolve test issues and re-test for functionality intact

Test of system once deployed to Production

Attend all conference calls in reference to internal and external updates

Health Plan Services

March 2010 – May 2013

Client Services/Account Resolution Specialist

Manage Escalated Inbound and Outbound calls via ACD

Respond to calls from agents, group contacts, and administrators with billing and enrollment issues

Perform monthly monitoring of Client Service Representatives/ Peer Coaching

Audit calls on Client Service Representatives

Manage day-to-day Billing and Enrollment SLA’s

Support objectives of team, department, and company

Liaison for internal and external relationships with customers and departments for problem and/or issue resolution

Customer service to All/ Processing requests/ Exceptions

Assists with all other functions and tasks as directed/Timesheets/Special Projects

Subject Matter Expert

Health Plan Services

2007 –2010- Life Claims Examiner

2004 – 2007 - Medical Underwriting

2000 – 2004 - Account Resolution Specialist

1993 – 2000 - Billing and Enrollment Specialist

Objective: To secure a responsible career opportunity, where I can fully utilize my Leadership, Data Base Support, Customer Service, Billing and Enrollment skills, while making a significant contribution to the success of my employer

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