Customer Service Quality Specialist Resume Example
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CUSTOMER SERVICE QUALITY SPECIALIST
Professional Summary
Dedicated Healthcare Administration professional with a history of meeting company goals using consistent and organized practices. Skilled in working under pressure and adapting to new situations and challenges to enhance the best corporate brand. Enthusiastic coordinator eager to contribute to team success through hard work, attention to detail, and excellent organizational skills. With an understanding and implementation of quality and process improvement. Motivated to learn, grow and excel in the field.
Skills
- Communication
- Multidisciplinary team collaboration
- Planning and development
- Research and data analysis
- Report preparation
- Compliance oversight
- Forward-thinker
- Problem solver
- Detail oriented
- Health Insurance benefit comprehension
- Resourceful and reliable
- Analytical thinker
- Excellent work ethic
- Self-motivated professional
- Flexible & Adaptable
- Communication
- Multidisciplinary team collaboration
- Planning and development
- Research and data analysis
- Report preparation
- Compliance oversight
- Forward-thinker
- Problem solver
- Detail oriented
- Health Insurance benefit comprehension
- Resourceful and reliable
- Analytical thinker
- Excellent work ethic
- Self-motivated professional
- Flexible & Adaptable
Education
Purdue University GlobalCityExpected in 01/2023Bachelor of Science:Health Administration
- Dean's List April 2021 Term
Colorado State UniversityCity, State2020Bachelor of Science:Health Administration and Management
Linn Benton Community CollegeCity06/2008Certification:Phlebotomy
Work History
Aegon - Care Management Coordinator
Duluth , MN01/2022 - Current
Duluth , MN01/2022 - Current
- Interpreted regulations to identify patient care requirement criteria to be monitored and established systems to achieve compliance.
- Coordinated referrals to specialists about Health Risk Assessments by identifying hospitalizations, ER visits, ancillary testing, and other enabling services for patients.
- Educated and evaluated health plans and support staff regarding care quality management regulations and standards of care.
- Coordinates activities/data with vendors and internal partners to ensure execution against contractual and requested services, including invoice reconciliation, reporting, etc.
- Developed and updated policies and procedures, maintaining compliance with statutory, regulatory, local, state, and federal guidelines relating to HIPAA, benefits administration, and general liability.
- Seeks out opportunities for process improvements/efficiencies and supports business initiatives.
- Collected and aggregated data to identify problems or trends, such as turnaround time and issues with outside contracts.
Toro Company - Customer Service Quality Specialist
Sanford , FL09/2016 - 12/2021
Sanford , FL09/2016 - 12/2021
- Problem solves and utilizes critical thinking skills to come up with innovative long-term solutions.
- Prepare detailed reports on updates to project specifications, progress, identified conflicts, and team activities.
- Communicates with leadership and staff when concerns are identified.
- Partner and collaborate with operations staff to ensure that benefits and programs are administered per regulatory, statutory, and plan-specific guidelines.
- Inspire, motivate, and guide others toward accomplishing goals and achieving desired results through effective team building.
- Maintain satisfaction with forward-thinking strategies focused on addressing agent needs and resolving concerns.
- Perform qualitative analysis of records to ensure accuracy, internal consistency, and correlation of recorded data for 18 plus agents.
- Establish efficient workflow processes, monitored daily productivity, and implemented modifications to improve personnel and activities' overall effectiveness.
- Complete ad hoc projects and reports for internal statistical needs as requested.
- Track employee performance; Analyze call center statistics to ensure optimal performance.
- Provide customer support to internal and external customers in a fast-paced environment.
- Address questions and manage communications with members and insurance agents.
- Transcribe meeting minutes for Management's records.
- Produce high-quality documents, spreadsheets, and presentations for internal and customer-facing needs using MS Office Suite.
- Develop internal requirements which complied with quality standards to minimize regulatory risks and liability across the designated department.
- Keep digital records organized for easy updating and retrieval by authorized team members.
- Prepared daily statistical reports to assist business leaders with crucial decision-making and strategic, operational planning.
- Help employees with day-to-day work and complex problems by applying motivational and analytical strategies.
Qualfon - Lead Customer Service Representative
Nj , NJ04/2015 - 09/2016
Nj , NJ04/2015 - 09/2016
- Strong leader of customer support staff.
- Trained and mentored more than 7 staff on operating procedures and company services for health insurance.
- Investigate and resolve customer inquiries and complaints empathetically.
- Met all customer call guidelines, including service levels, handle time, and productivity.
- Identify individual development needs with appropriate training for designated team members.
- Follow-through on critical inter-departmental escalations to increase customer satisfaction, communication, and process improvement needs.
- Effective liaison between customers, representatives, and internal departments.
- Delivered world-class customer service.
- Planned schedules and created workflows based on expected customer demands.
- Efficiently executed regular process updates to reduce discrepancies and enhance communication
- Encouraged and streamlined process improvement for the team as a whole.
Universal Health Services - Customer Service Representative
Clifton Heights , PA02/2014 - 04/2015
Clifton Heights , PA02/2014 - 04/2015
- Politely assisted customers in person and over the phone in regards to health insurance questions and concerns.
- Managed customer calls effectively and efficiently in a complex, fast-paced, and challenging call center environment.
- Act professionally and patiently when addressing negative customer feedback.
- Met or exceeded service and quality standards every review period.
- Answered 30 to 50 plus inquiries daily between agents, members, and providers.
- Mastery of customer service management systems and databases.
- Referred unresolved customer questions and concerns to the appropriate department for further investigation.
- Accurately documented, researched, and resolved customer questions, concerns, and conflicts.
- Documented and detailed calls and complaints using Facets database.
Company Name - Lead Medical Office Specialist
City, State09/2008 - 02/2014
City, State09/2008 - 02/2014
- Scheduled appointments, registered patients, and professionally and courteously verified appointment times with patients.
- Managed over 7 provider schedules at any given time.
- Worked with 6 different departments. Including Sleep Medicine, Gastroenterology, Urology, Immediate Care, General Surgery, and Coumadin Clinic to check-in and assist with patient appointments, paperwork, questions, and concerns.
- Adeptly managed multi-line phone system and pleasantly greeted all patients.
- Prepared patient paperwork and consent forms as necessary.
- Determined if prior authorizations were needed for outpatient procedures.
- Meticulously identified and rectified inconsistencies, deficiencies, and discrepancies within the designated department.
- Communicated and verified with patient insurance coverage, deductibles, possible insurance carrier payments when applicable.
- Researched questions and concerns from providers, patients and provided detailed responses.
- Treated all patients, their families, visitors, peers, staff, and providers in a pleasant and courteous manner.
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Resume Overview
School Attended
- Purdue University Global
- Colorado State University
- Linn Benton Community College
Job Titles Held:
- Care Management Coordinator
- Customer Service Quality Specialist
- Lead Customer Service Representative
- Customer Service Representative
- Lead Medical Office Specialist
Degrees
- Bachelor of Science : Health Administration
Bachelor of Science : Health Administration and Management
Certification : Phlebotomy
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