Community Support / Outreach Professional (5+ yrs)

Joan Campinha

*** ****** ******

East Providence, RI 02914

ph. # 401-***-****

Email: ******@***.***

Professional Overview

Detailed-oriented with extensive project management and dynamic problem solving experience. Self-motivated in establishing a career in helping people through quality work, relationship building and perseverance.

SUMMARY OF QUALIFICATIONS

Account Management

Customer Service Credentials

Attentive to details, Able to work independently without supervision, in fast paced environments

Excellent verbal/written and analytical skills

Ability to multitask and prioritize multiple projects

Fluent in Cape Verdean.

PROFESSIONAL EXPERIENCE

AETNA Inc., Home-base, RI 2015 – 2024

Senior Account Manager

Help manage and provide technical guidance through the implementation of new client Web sites

Test client sites for quality assurance; track and monitor the resolution of issues

Prepare and conduct technical/product presentations, demonstrations and trainings (such as an open enrollment demo for new/changing plans, site text, and release functionality changes, etc.)

Provide resolution of client issues by responding to questions and concerns; ability to leverage research to find resolution

Maintain thorough understanding of all internal systems to respond to general and specialized client requests

Triage client tickets and/or questions (email and voicemail) within 24 hours; maintaining ownership from initial customer contact to call resolution which includes supporting escalations if appropriate and providing customer updates

Look for and help drive continuous process improvements/efficiencies by maintaining a thorough understanding of all internal systems

Develop and implement fulfillment procedures

Lead and create agendas for client meetings (when CRM is not available)

Coach and mentor other team members

Manage workflow in the setup and maintenance of carrier and payroll feeds

Assist in sales and marketing activities as needed

Provide open communication to account team in a pleasant, professional manner with a can-do attitude

Catamaran, Home-base, RI 2013 – 2015

Implementation Project Manager

Manage and lead new Health Plan (all sizes) implementation, including Commercial, Medicaid, Medicare, and Exchange lines of business

Develop detailed work plans, schedule estimates, resource plans, status reports, and implementation priorities

Direct and coordinate the teams of operations, business, product and technical contributors to ensure the on-time, within budget, successful delivery of properly scoped high quality project requirements •

Ensure factual, timely, and quality implementation tracking, analysis, reporting and communication strategies are utilized using established policies & procedures •

Proactively manage client expectations & performance guarantee commitments by partnering with all internal & external project stakeholders. Support the Sales process with client RFP responses, pre finalist support, and represent Optum Rx Implementations at finalist meetings

Serve as Lead communicator for overall project status, with regard to issues, risk, & mitigation strategies for clients, OptumRx, & Optum IT. Provide OptumRx readiness reporting & Optum Elevate readiness reporting.

Ensure Service Now automated work flow tool updates are timely and meet QA standards to ensure 100% accuracy per timeline for each implementation. Manage internal team updates to the client SN implementation case to ensure completeness

Provide technical, business, analytical, and strategic guidance to entire ORX implementation team. Attend all IT development meetings to ensure contractual obligations are met and meet regularly with IT lead on progress and obstacles to deploy

Review deliverables and ensure adherence to quality standards, implementations and team performance measurements

Obtain sign-offs on all deliverables from key internal & external project stakeholders. Make timely and appropriate decisions to ensure implementations are on track for successful service and go live readiness

Recommend and take necessary actions to direct the analysis and solutions of problems; escalate when needed.

Partner with Account Management to ensure all implementation items are tracked, documented and closed, in agreement with the client intent • Lead cross-functional quality initiatives centered on improving the implementation process, & post go live lessons to learn reviews with clients and executive leaders

Catamaran, Home-base, RI 2012 – 2013

Account Manager, Managed Drug Card

Responsible for reviewing, analyzing, and implementing desired plan benefit features including formulary loads and performing quality assurance checks by testing claims against the desired benefit design

Ensures accurate claim processing by communicating discrepancies found in set-up and/or quality assurance testing and recommends appropriate plan set-up changes and/or system modifications when required

Coordinates with internal and external customers to ensure the documentation, implementation, and modification of benefit plans is completed on a timely basis and is updated according to Catamaran policy and legal requirements.

Responsible for researching, testing, and responding to inquiries regarding system capabilities and system problems related to plan benefit design from other internal departments such as Client Services and/or Quality Assurance

Responsible for the accurate and timely entry of plan benefit setups and maintenance revisions into the RxCLAIM system

CVS Caremark, Home-base, RI 2010 – 2012

Account Manager, Sales and Account Services

Responsible for acting as client’s advocate within CVS Caremark.

Secure requested product/service upgrades and coordinate day-to-day account administration.

Responsible for matching client priorities with CVS Caremark capabilities and objectively analyzing and evaluating any special arrangements the client may require.

Monitor account activity, report participant trends, and, when appropriate, recommend and implement plan design changes.

Manage client-related projects involving other CVS Caremark departments to resolve any problems or issues, and engage in any follow-up activities needed to ensure total client satisfaction.

Successfully implemented Affinity Health Plan for 1/1/12, which included managing the overall implementation process for new health plan business.

SME on both QL and Rx Claim adjudication platforms

Knowledge of CVS Caremark’s benefit plan designs, PBM programs, PBM operating systems, and clinical programs.

Benefit Concepts, East Prov RI 2008-2012

Implementation Specialist, Continuation Benefits

Responsibility involves working with new and existing COBRA, Direct Bill and RAS clients to ensure that business

and benefit rules are implemented and maintained appropriately

Implementing all required information from clients, vendors, and/or internal parties

Creating and managing an authorized project plan/timeline

Prioritizing and analyzing information to determine appropriate benefit setup

Facilitating technical discussions with internal departments and assigned clients in order to appropriately configure benefit rules and provisions.

Using all gathered information to develop and manage project timelines, finalize all required client documentation, and fully set up the client within the benefit administration systems

Using knowledge-base about various benefit categories, plans, rules, and provisions to assist the implementation process

Operating within current workflows to ensure timely, accurate, and successful project implementations

Communicating/facilitating all related issues and updates with internal parties at Benefit Concepts (BCI), and with external parties (client, fulfillment vendors, etc.)

Researching and processing payment exceptions

Producing various reports and regular monthly reports.

Working in concert with Customer Service to resolve issues.

PART-TIME

Citizens Bank, Riverside, RI 2014 - Present

Client Services

Serve Cash management, ACH and Commercial Card customers via request received by telephone, Chat, or email

Research and train clients on all products offered

Independently service both internal and external customers on a wide variety of Commercial Card, ACH & cash management products, services, and technical issues through all incoming channels

Diagnose, prioritize, resolve and/or escalate all technical, system, or procedural issues

Partner with various operational support staff in the reconciliation of client problems while attempting to limit future occurrences

Proactively advise management of impending problems or obstacles to meeting service standards

Research problems and provide customer with resolution within established timeframes

Work with various operational support staff in the reconciliation of client problems while attempting to limit future occurrences

EDUCATION

Johnson & Wales College, Rhode Island

Community College of Rhode Island

COMPUTER SKILLS

Windows NT, Windows 95/98, MS Excel, Word and Microsoft 97

Various in-house corporate database, HRIS

REFERENCES

Will be furnished upon request

Contact this candidate