Customer-focused with 19+ years experience in the Health Insurance Business dealing with a wide variety of customer and vendor types. * In-depth knowledge of Pre-Sales, Sales, Individual, Marketplace and Group Membership/Billing and enrollment environments with the ability to adjust to change. *Ability to work independently and/or as a team* Self-motivated, detail oriented, while maintaining accuracy. * Proven ability to multi-task and learn new tasks quickly. * Working directly with consumers and current BCBST members. Providing first class customer service for all BCBST members, inside and outside brokers/agents. Providing the community, individual consumers and key business constituencies with proactive education and service support. 3 years in a leadership role as TTE 10 years of Individual Membership/ Billing / Sales 7 years of Group Membership / Billing 19 plus years of relevant health insurance experience Working knowledge of applicable systems .
Facets, Workflow, CRM Tool, Sales Logix, IPD/Filenet imaging software, Microsoft Office ( Word, Excel , Access), Blue Connections, eCopy Desktop, and RightFax Utility; CRM Tool |
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•Completed TTE Leadership Program, Lean Six Sigma Yellow Belt Training, and completed Service Mentor Ulysses Training
•3 years in a leadership role as TTE
•10 years of Individual Membership/ Billing / Sales
•7 years of Group Membership / Billing
•19 plus years of relevant health insurance experience
- Professionally handle incoming telephone calls from Internal and External customers Take appropriate action to resolve the question or complaint timely and accurately Utilize FACETS, Sales Logix, imaging systems, business rules, and workflow to correspond with members and applicants regarding application, policy and billing status Process payments over the telephone via Authorizer Software for customers Perform the process for issuing letters regarding subscribers' payment history at their request Handle policy cancellation requests and initiate premium refunds where applicable, including those for deceased subscriber contracts.
- Assure member terminations are handled in accordance with group master contract provisions, federal/state mandates and corporate procedures regarding retroactive terminations Document and log all phone calls in designated inquiry system regarding subscriber, broker and group inquires Maintain accurate and timely management reports including phone call reason log, weekly productivity report and weekly pending item inventory/aging reports Maintain acceptable MTM quality accuracy based on division guidelines Meet or exceed individual phones goals set for categories such as: time logged onto the, phone system; not ready time, talk time, etc.
- Achieve and maintain at a minimum the divisional quality and productivity goals Meet attendance, quality, and productivity expectations based on established standards Completed Service Mentor Ulysses Training.
- Organize the workload in the department to maximize productivity, improve efficiency and enhance workflow Completing Daily/Monthly Reports in timely manner.
- Responsible for timely and accurate performance reporting.
- Ability to function in team environment and share responsibilities with management and other staff within department and outside the department Available to employees on a daily basis in order to facilitate prompt and accurate service to internal and external customers Responsible for Training New and Existing employees Responsible for continuous education of potential problem areas and new and upcoming changes Identify, research and resolve high profile issues Prepares and conducts team meetings/quality meetings in order to improve the overall performance of the team Accountable for ensuring that all division, corporate and contractual standards goals are met Ability to be aware of and meet internal and external guidelines as well as federal and state mandated statutes as applicable.
- Attend meetings as required as required by management Assists Staff when needed, the ability to handle all job functions in the department Test, implement and improve processes within Workflow and other systems for the Application Operations area Excellent organizational and interpersonal skills; Completed TTE Leadership Program; Completed Lean Six Sigma Yellow Belt Training.
- Pre-Sales, Application Operations Individual Products, Assigned to research issues for manager.
- Support Sales, Pre-Sales, HOST and FAST needs Piloted, tested, and improved the telecommuting initiative in line with V.I.P.
- Test, implement, and process Sales applications within Blue Connections and Workflow for the Individual Product area.
- After hours implementation of new systems to go "live" with User acceptance testing.
- Electronically process Individual E-Health, paper and miscellaneous applications and Individual correspondence including issue recognition, escalation, and resolution.
- Call experience handling issues for the Home office support technicians, external Brokers and internal Sale Reps, Field agent support technicians, and other internal departments.
- Primary support for Analyze Attachment flow and PA01 flow in Workflow system.
- Train and educate peers, management, and high-volume producers on job functions.
- Responsible for coordinating pre- and post-sale activities and satisfying outstanding requirements.
- In depth understanding of processing flow including BCBST receipt, payment methods, error correction, Sales processing, phone response, imaging, mail, etc.
- Responsible for Enrollment Applications for the Nashville Region and the maintenance of the changes.
- Billing for over 300 groups and served as Single Point of Contact Person for the Nashville Region and Marketing Support Tech for our Account Management Team in the Nashville Region.
- Complete requests within 24 to 48 hours while handling misc.
- tasks such as filing, etc.
- Selected as user acceptance tester for the new Imaging and Workflow System.
- Handle monthly billing, new and changes for enrolment, medical underwriting for life insurance, reconciliations and adjustments for assigned accounts.
- Perform complete lifecycle of enrollment; including enrollments, exception decisions, changes and terminations within automated workflow and or manually processed paper documents within specified timeframes.
- Reconcile billed amounts to amounts paid by the group or member and identifying any discrepancies.
- Provide internal and external technical support for any special projects that are deemed necessary to support Division and or corporate activities.
- Single Point of Contact for group administrators and brokers.
- Provide exceptional level of service to brokers and group administrators that maximizes satisfaction with BCBST to ensure commitment of our existing business and to foster growth of new business.
- Maintained excellent Pride and Quality Performance.
- Help organize the Division United Way Fund Raiser.
- Proven claims experience processing 100 plus claims per day while maintaining accuracy.
- VOLUNTEER EXPERIENCE Worked on the Employee Appreciation Week for corporate and for the Membership Divisional Appreciation Week for 2012 United Way help organize division fund raiser: 2005 Foster Parent with Omni Visions Agency: 2005-2008. Candy Striper with the Red Cross at age 14
•Proficient in Facets, Workflow, CRM Tool, Sales Logix, IPD/Filenet imaging software, Microsoft Office ( Word, Excel , Access), Blue Connections, eCopy Desktop, and RightFax Utility; CRM Tool
•Ability to make decisions and work independently
•Excellent interpersonal and organizational skills
•Ability to function in a team environment and share responsibility, roles, and accountability with co-workers and other support staff
•Ability to handle large volumes of work, solve problems through sound decision making and manage multiple assignments while meeting critical deadlines.
•Ability to communicate ideas in verbal and written form
•Completed TTE Leadership Program, Lean Six Sigma Yellow Belt Training, and completed Service Mentor Ulysses Training
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School Attended
- Hixson High School
- Chattanooga State Community College
Job Titles Held:
- Customer Service Representative Individual and Marketplace Plans
- Team Leader
- Sales- Marketing Support Technician
- Marketing Support/Billing Technician
- Claims Processor
Degrees
- High School Diploma
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