Business Analyst Customer Service
Resume:
High School Diploma:
West Oso High
Marketing/Management:
Del Mar College
*************@*****.***
San Antonio, TX 78245
Skills
• Workflow Analysis
• Data Mapping
• Data Analysis
• Business process improvement
• Quality Assurance
• Microsoft Office Suite
• Process Improvement
• Training and mentoring
• Goal-Oriented
• Complex Problem-Solving
• Customer Service
• Customer follow-up
• Understanding of medical terms
• Data Security and Confidentiality
Documentation and
Correspondence
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Communication and
Interpersonal Skills
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• Attention to Detail
• Coordination and Scheduling
• Insurance terminology
• Eligibility Determination
Education
Knowledgeable Insurance Benefit, specializing in all payers, managed care, managed Medicare, supplement, and Medicare, and bringing 19 years of related experience. Conscientious about completing thorough reviews to better serve patient needs with current, effective systems. Excellent decision-making and prioritization skills.
3m Healthcare - Business Analyst
San Antonio, TX
07/2005 - 03/2024
Business Analyst:
Supervisor:
Herlinda Recio
Objective
Experience
Conducted market research to identify potential opportunities for new product development.
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Analyzed departmental data to determine trends in customer and business behavior.
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Collaborated with stakeholders across departments to define requirements for new process.
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• Created detailed process flows and standard operational processes.
• Analyzed payor data to determine trends in payor behavior. Conducted interviews with subject matter experts to gather information on existing systems and procedures.
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Designed test plans, scenarios, scripts, cases, and results matrices to validate system functionality.
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Reviewed existing policies and procedures against industry standards for compliance purposes.
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Maintained library of model documents, templates, or other reusable knowledge assets.
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• Directed and supervised a team of 10 employees in daily operations. Developed and implemented operational policies and procedures to ensure efficiency and accuracy of workflows.
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Maintained accurate records of employee performance, attendance, leave requests, and disciplinary actions.
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• Tracked progress on projects and provided timely feedback to staff members. Conducted daily meetings with team members to discuss upcoming tasks and deadlines.
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Recruited, hired, trained, mentored, coached, evaluated, and terminated staff as necessary.
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Monitored employee productivity levels on a regular basis to identify areas of improvement.
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• Collaborated with other departments to coordinate workflow processes between Senior Representative:
Aetna - Customer Service Representative
San Antonio, TX
10/2002 - 07/2005
Sears - Account Customer Service Representative
San Antonio, TX
08/2001 - 09/2002
teams.
Resolved customer complaints in a timely manner while ensuring customer satisfaction.
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Initiated telephone calls to insurance companies to obtain information on benefits, eligibility, and authorization.
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Managed individual durable medical equipment accounts/orders with precision, accuracy, and timeliness.
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• Successfully obtained recertification for expiring authorizations and referrals Consistently communicated with patients to ensure they received necessary benefit details and addressed any concerns (Managed care, Medicare, Medicaid)
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Handled incoming calls and resolved complex issues as part of senior Support center team
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Provided education to customers regarding insurance plan policies and the exclusion of durable medical equipment
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• Implemented strategies to achieve highest rate of first-call resolutions Reduced average handling time and after-call work time to meet or exceed set targets
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• Learned and mastered multitasking skills in the department.
• Assisted supervisor and lead with phone duties.
Served as a liaison bridging the gap between members and health/dental providers, effectively addressing concerns pertaining to billed procedures and billing.
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Efficiently managed the correspondence between members, insurance companies, and medical/dental providers through tasks like handling faxes, letters, and telephone calls.
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Handled customer issues in a professional, sincere manner to ensure first call resolution for Aetna clients
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Executed claim processing in accordance with Aetna's guidelines and plan sponsors' requirements.
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• Reviewed and optimized insurance policies for regulatory compliance. Provided prompt responses to customer inquiries and delivered timely updates on policies as required.
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Maintained strict confidentiality of customer data in compliance with relevant laws and regulations.
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• Provided support to customers inquiring about their Sears Credit accounts
• Approved sales fro Sears and third-party merchants Streamlined customer's incoming calls for scheduling or cancelling repairs on appliances, electronics, and lawn equipment; answered questions about products and service agreements
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Contact this candidate