Customer Service Quality Assurance

APRILMINER

AprilMinerHIA,HCSA

***********@*****.***

312-***-****

● FifteenyearsofCustomerService/clientservicesexperience.

● Oversixyearsofinsurance/financial processinginhigh-volumeenvironments whileresolvingaccountsandaccountreconciliationasclientrequests.

● Over6yearsofVolunteeradministrativesupportworkforaCHAapprovedPropertyOwner.

● Professionalknownformakingsupervisorydecisions,usingdiscretionandprocessinghighly confidentialinformation.

● Maintainpatient/clientconfidentialityinaccordancewithHIPAA/Privacyregulations.

● Monitored,audited or performed financial and insurance transaction processing while workingforJPMorganChase,CNOFinancialandMaximusGovernmentContractor.

● Strongproblem-solving,softskillsandteamwork.

● ProficientinMicrosoftOffice,Insuranceandfinancialsystems.

● Quality Assurance experienceforMedicaidredeterminationproject,CallCenterandHealth insuranceProducts.

● LocatedinChicago,ILwiththeflexibilityforaninterview Education:

GED Graduated:November2011

IssuedbythestateofIllinoisandCertifiedbytheRegionalOfficeofEducation DeVryUniversity Chicago,IL CollegeCredits:January2012–April2014 BusinessAdministration&ProjectManagement

Designations

HealthInsuranceCustomerServiceAssociate(HCSA)March2003 HealthInsuranceAssociate(HIA)March2002

Skills:

● CriticalThinking

● MicrosoftTeams

● Symphony

● Client/CustomerFacing

● CallCenter

● Adaptability

● Compliance

● CustomerService

● EffectiveCommunicator

● Microsoft365

● ProblemSolving

● MicrosoftSharePoint

● GovernmentHealthplans

● MedicalTerminology

● ClaimReviewProcessing

● CashHandling

● Databasesystem

● SchedulingmeetingsviaOutlook

● OperationalSystems

● Bankingproductknowledge

● HealthinsuranceProductknowledge

● InsuranceSupportAdministration

● AccountReconciliation

● ThinkingCreatively

● Coaching&Development

● ACHTransactions

● HIPAA/PrivacyRegulations

● Avaya

● DocumentingDesktopProcedures

● Clerical

● BusinessAdministration

● Clerical

● Documentationreview

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APRILMINER

WorkExperience:

JewelFoods(Current)-Chicago,IL July2023-current

Cashier,ServiceCenterAdministration

Cashier/Service checks for grocery items using accuracy,different tenders,and look up keys to ensure a seamless Customer experience.Issuing refunds,updating transit values,issuing money orders,directingphonecalls andcashhandling.

● Moneytransactionhandling

● CustomerService/CustomerFacing

● Adheringtostateandlocallawspertainingtothesaleofalcohol

● Criticalthinking

● Multi-tasking

● Strongattentiontodetail

● Trained new cashiers to ensure consistent performance and adherence to company guidelines.

● Selfcheckoutattendant

● GuestServiceDesk

Sedgwick-Chicago,IL March 2023-May2023

LeaveofAbsenceSpecialist-BusinessAdministration

ProcesseligibilityanddenialsforFamilyMedicalLeaveAct.

● ProcessingInformation

● Casemanagement

● Determiningbenefitperiods

AppleOne/JPMorganChase(Contract)-Chicago,IL October2021–April2022 ClientServiceRepresentative-BusinessAdministration

● Executed decedent beneficiary payouts for the EstaCollaborated with internalandexternal serviceareastocompletetheintakeprocess

● ConductedonlinePrecertificationofRadiologyandSurgicalexams

● Identifiedserviceneeds

● CommunicatedwithProviders,Supervisors,Peers,orSubordinates AppleOneEmploymentAgency,INC(Contract)-AIM/AnthemRemote February2021 June2021

ReferralSpecialist-BenefitsAdministration,CallCenter

● PerformedremoteintakeprocessforAnthem/AIMHealthcare

● Collaboratedwithinternalandexternalserviceareastocompletetheintakeprocess

● ConductedonlinePrecertificationofRadiologyandSurgicalexams

● Identifiedserviceneeds

● CommunicatedwithProviders,Supervisors,Peers,orSubordinates GHarmanian-Chicago,IL January2016–February2021

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APRILMINER

Volunteer Role Virtual Assistant-Support Service,Clerical,Business Administration,Property Administration

● Opened,read,routed,anddistributedincomingmailorothermaterial.

● Cash-handlingtransactionsover$3000

● FollowedCHAandChicagorentalguidelines

● Resolvedtenant/Vendorqueries

● Inspectionpreparation

● Screenedpotentialresidentsandhandledpropertyshowings TheCentralStatesHealth&WelfareFund–Chicago,IL June2013–August2014 BenefitSpecialist-BenefitsAdministration,CallCenter

● BenefitadministrationinalargeNPOCallCenter

● Handledahighvolumeofinboundcalls

● Proactively assisted members with benefit,pension,claims,andWEBnavigationquestions throughemailcorrespondenceandinbound/outboundcalls

● Collaboratedwithvariousentitiesregardingmemberfacts,claimhandling,subrogationlaws, andpensionquestions

Maximus(GovernmentContract)–Chicago,IL Dec2012–June2013 QualityAssuranceSpecialist-CallCenterCompliance

● Identifiedqualityproblemsandrecommendsolutions

● Wroteandrevisedstandardqualitycontroloperatingprocedures

● Participatedininternalassessmentsandauditsasrequired

● Monitoredprocessesoftransactions

● Evaluatedinformationtodeterminecompliancewithstandards CNOFinancial–Chicago,IL March1990toMarch2011

Senior Quality Specialist/Claim Review/Vendor Manager Support/Customer Service,Call Center,Compliance,BenefitAdministration

● Provideddirectadministrativesupporttotheassignedmanagerandsupervisor

● Supported the following teams and departments:Quality Assurance Manager,Vendor Manager,ClaimReviewManager,andClaimAudit/CustomerServiceSupervisor

● Monitoredandauditedthecustomerservicedepartment

● TrainedonsiteandoffshoreQAstaffonprocedures,processes,andsoftware

● Developed material and trained customer service Staff on internal procedures andQuality Application

● Reported,Analysis,andQualityMetrics,ad-hocreportingperrequest

● Participatedinprojects&initiativesdesignedtostreamlineprocessesandenhancedsystems

● DevelopedautomatedchecklistandreportingtemplateusingExcel

● Updated source material-Responsible for updating source material for Health,Life & AnnuityCustomerServiceintranetlink.

● Re-calculatedtheamountoftheclaim

● Transmittedclaimsforpaymentorfurtherinvestigation

● CollaboratedwiththeManagedCareAreainregardstoclaims.

● Organizedorworkwithdetailedofficerecords,usingcomputerstoenter,access,search,and retrievedata

● Examined original insurance applications,claims and other company documents to determine if changes are needed and the effects of changes.Responded to letters from policyholders,and representatives in regards to Executive Complaints and Claim Legal Cases.

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APRILMINER

● Calculated premiums,refunds,commissions,adjustments,or new reserve requirements, utilizedinsuranceratestandards

● Communicatedwithpolicyholdersandhandledcallstoprovidecustomerserviceandobtain informationonclaims

● Reviewedinsurancepolicytodeterminecoverage

● Memberofbrandingcommittee

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