Customer Service Quality Assurance
Resume:
Lori Richmond
adz7kj@r.postjobfree.com
Extensive customer service experience
Detail oriented and adapts quickly
Team player with the ability to work independently
Excellent data entry
Microsoft Office, Excel, Word, Outlook, Adobe Standard, CR, CRM, and MEDS
15 + years’ experience
Education:
1994 San Francisco State University, San Francisco, CA
B.A., Spanish, Education
1984 Diablo Valley College, Pleasant Hill, CA
A.A., Hospitality and Restaurant Management
Employment:
Catylex 04/2022-08/2023
An early-stage contract analysis software company that is used by legal professionals.
Content Analyst
Data Cleansing
Model Development
Quality Assurance
Knowledge Management
L.A. Care Health Plan/Accenture/Experis 12/2021-4/2022
This health plan offers high-quality, affordable health coverage to Los Angeles County residents.
Appeals and Grievance Specialist
Identified, investigated, and resolved administrative complaints adhering to CMS, DHS, DMHC, MRMB, and NCQA standards
Prepared case files and routed complaints to appropriate internal departments for further investigation and resolution, exercising strong independent judgment.
Monitored closure of complaints
Performed clean-up on cases that had not been completed by prior agents
Catylex 12/2020-12/2021
An early-stage contract analysis software company that is used by legal professionals.
Data Analyst
Market research
Interface testing
Data cleansing
TriWest Healthcare Alliance 12/2016-10/2020
This is a Phoenix, Arizona-based corporation that manages health benefits under the U.S. Department of Veterans Affairs.
Customer/Patient Services Representative
Assisted customers over the phone regarding claims, eligibility, creating and building authorizations, setting appointments, and working accounts to make sure that the veteran received the care needed.
Resolved conflicts between veterans, providers, and the V.A.
Interacted with both military and civilian providers and beneficiaries ensuring reliable and current information was always available.
Developed highly empathetic client relationships.
Researched and built authorizations for the veterans.
Met or exceeded expectations in quality assurance and quality control.
Documented inquiries thoroughly to ensure historical integrity.
Promoted to permanent staff position 03/2017 from Aerotek staffing agency.
Maximus/Health Care Options 08/2014-12/2016
Medicare provider that helps Americans have access to affordable healthcare.
Customer/Client Service Representative
Responsible for assisting customers in their enrollment in the state Medi-Cal program.
Responded to customer inquiries in a fast-paced call center environment with a focus on “one call resolution.”
Documented inquiries thoroughly to ensure historical integrity.
Met or exceeded expectations as to customer service goals, call handling times, and quality control.
Utilized multiple systems, including CRM and MEDS to process inquiries and enrollments.
Routed cases to appropriate departments to resolve customer issues.
Assisted in training new employees.
Promoted to full-time staff position 04/2015 from FutureWave staffing agency.
Elk Grove Treasures 8/2012-06/2014
Artisan Gift Shop features handmade home décor and specialty gifts.
Floor Manager
Responsibilities included running the store’s daily operations.
Merchandising
Customer Service
Michael’s Stores 8/2012-09/2013
Arts and crafts supplier
Instructor
Responsibilities included scheduling classes.
Conducting store demonstrations
Product selling
Customer service
Class instruction
Patrick K. Willis, Inc./American Recovery Service 03/2005-04/2012
Repossession portfolio management services firm
Customer/Client Service Representative
Intermediate between repossession agents and bank clients.
Documented inquiries thoroughly to ensure historical integrity.
Efficiently solved client challenges
Performed research and investigations into all accounts.
Maintained quality control/satisfaction records, consistently seeking new ways to improve client services.
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