LiveCareer-Resume

customer service supervisor of member and provider resume example with 19+ years of experience

Jessica Claire
  • , , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
  • H: (555) 432-1000
  • C:
  • resumesample@example.com
  • Date of Birth:
  • India:
  • :
  • single:
  • :
Summary

Hardworking Bilingual Provider and Member Service Supervisor with over 20 years of experience in customer services and 8+ years in the health care industry. Solid team player with upbeat, positive attitude, enthusiastic and results-oriented with demonstrated passion for building relationships, cultivating partnerships and growing businesses, and proven skill in establishing rapport with members and providers. Motivated to maintain customer satisfaction and contribute to company success by quickly and effectively resolves complex issues, accustomed to fast-paced environments. Quickly and effectively understands, documents and resolves customer concerns, driving satisfaction while meeting demanding business objectives. Highly-knowledgeable in MMA, CWSP, Ambetter, provider LOB standards and best practices. Familiar with analyzing documentation, liaising between parties and handling both routine and complex issues each day. Identifies and resolves concerns while promoting new products and meeting service levels, and goals for the department. Dynamic professional with mentoring and coaching skills.

Skills
  • Call Center Operations
  • People Management
  • Provider Services
  • Knowledgable on multiple line of business, Medicaid, Child Welfare, Ambetter, LTC, SMI
  • Report generation
  • Customer relations
  • Problem-solving abilities
  • Health Care regulations knowledge
  • Business development understanding
  • System implementation
  • Project management abilities
  • Data evaluation
  • Inbound and Outbound Calling
  • Microsoft Office expertise
  • Excel proficiency
  • SharePoint proficiency
  • MicroStrategy Knowledge
  • Beeline proficiency
  • Adaptive team player
  • Courteous demeanor
  • Proficiency with the following systems Omni, Amisys, Portico, Cenpass, TruCare Cloud, CVS Pharmacy Portal, NIA portal, EDS, Central Point, etc.
  • Senior leadership support
  • Ability to thrive in a fast-paced environment.
  • Collaborate effectively within and across departmental lines.
  • Flexible
  • Ability to travel
Experience
Customer Service Supervisor of Member and Provider, 07/2013 - Current
Oatey Omaha, NE,
  • Supervise the day to day call center member/provider service operations
  • Ensure the team meets its goals and objectives through performance management, coaching and career development.
  • Trained employees on additional job positions to maintain coverage of roles, such team leads and new supervisors in the role.
  • Assigned tasks to my team lead to fit skill levels and maximize team performance.
  • Recruited and hired qualified candidates to fill open positions for member and provider services.
  • Triage complaints they are routed to the appropriate parties and resolved accordingly.
  • Collaborated with staff to maximize customer satisfaction, streamline procedures and improve bottom-line profitability.
  • Built relationships with internal team members and external partners to enhance effectiveness of team's work and boost their performance and motivation. Work hand to hand with other departments such member advocate, provider operation unit, provider relation team to effectively identify and resolve claims issues and member complex issues.
  • Work in collaboration with training department to develop, implement and maintain policies and procedures, ensuring production and quality standards are met on every quarter. Established and created training programs to enhance employee knowledge of best practices, resulting in improved customer satisfaction.
  • Maintained ongoing system for development, recruitment, recognition and retention of staff and management.
  • Evaluated operational trends and proactively adjusted strategies to maintain alignment between performance and objectives.
  • Managed shifts in absence of on site manager to deliver excellent customer service.
  • Delivered level of service to members and providers in effort to build upon relationships for future customers.
  • Interviewed, hired, onboarding 15+ team members and trained and mentored formally and informally, developed and promoted according to performance and fostered collaborative team environment.
  • Submit changes request access for new hires, conduct new hires orientations, shadow and nesting at the end of their training.
  • Upheld company's high standards for business via leading by example and encouraging team members to adhere to corporate policies.
  • Supervised staff performing daily activities.
  • Completed daily reports and analyzed metrics to identify trends such quality, adherence, attendance, etc
  • Adhered to health plan policies and procedures to maintain regulatory and legal compliance.
  • Conducted regular evaluations, coaching and addressed performance concerns directly with employees.
  • Implemented and enforced policies and procedures by coordinating with company leaders, coaching employees and overseeing staff activity.
  • Investigated misconduct, mediated problems and determined appropriate disciplinary action for staff.
  • Set challenging yet attainable goals to encourage continuous staff development.
  • Drove quality assurance and effective evaluation, modification and improvement of services and developed work plans consistent with program goals and objectives.
  • Maintained team progress against performance targets by motivating staff and proactively resolving department-level issues.
  • Run and analyze Omni aging report for the local health plan and identify aging items over days for the health plan workbasket and worklists, and managed communication within organization and other departments and partners and thoroughly documented and reported weekly activities to management.
Team Lead, 07/2013 - 05/2015
Genworth Financial Richmond, VA,
  • Monitored team progress and enforced deadlines.
  • Review call queues and implement action steps forward effective management of call queues.
  • Monitor and assist team performance and productivity for front line staff. Fostered positive employee relationships through communication, training and development coaching.
  • Assist other departments with special projects as needed.
  • Resolve complex medical, billing, claims and pharmacy inquiries.
  • Documented production levels, materials used and special incidents to keep management informed of daily activities.
  • Developed and monitored weekly staff schedules.
  • Offered constructive criticism regarding quality assurance on team phone calls.
  • Promoted to leadership position in recognition of strong work ethic and provided exceptional customer service.
  • Assessed, motivated and empowered team members to work to build customer satisfaction and loyalty, to support retention and growth.
  • Resolved escalated and complex issues by using skills in customer service and provider and escalated high-level issues to the appropriate unit for assessment.
Senior Customer Service Representative, 09/2001 - 06/2012
T-Mobile City, STATE,
  • Met and exceeded performance goals to support long-term company growth and market dominance.
  • Managed customer conflicts and challenging situations by staying calm and accessing internal knowledgebases to develop strategic solutions.
  • Assisted customers by answering questions, addressing concerns and providing current account information.
  • Educated customers about products, pricing and policies to address and resolve issues.
  • Reviewed customer account information to determine current issues and potential solutions.
  • Oversaw and guided team of 14-18 to handle customer call escalations, training and mentoring new employees on customer service and order processing.
  • Improved customer satisfaction and retention by proactively reviewing new customer accounts and reaching out to offer assistance.
  • Handled calls for new sign-ups, service cancellations and cross-selling opportunities.
  • Processed customer account changes with proprietary software.
  • Collated customer names, contact and payment information to streamline future interactions.
  • Revised chargeback processing, increasing collections efficiency and minimizing fraudulent credit card abuse.
  • Delivered expert technical support to customers and resolved broad array of issues.
Education and Training
Associate of Science: Business Administration, Expected in 05/1993
-
Universidad Monsenor De Talavera - Cabimas, Venezuela,
GPA:
Status -
Real Estate Associate: Real Estate, Expected in 01/2011
-
Gold Coast - Tamarac, FL,
GPA:
Status -
Languages
Spanish :
Native/ Bilingual:
Negotiated :
:
Accomplishments
  • Recognized on 2019 for achieving 100% Employee Satisfaction Survey earning recognition from upper management and financial reward.
  • Led team to improve and achieve high performance every quarter for three consecutive years 2017, 2018, 2019, recognized by management for outstanding performance and team contributions.
  • Created highly effective new tracking form called Supervisor Grow Form in SharePoint that significantly impacted efficiency and improved operations.
  • Consistently maintained high customer satisfaction ratings.
  • Manager Assistance - Worked with company systems such as Omni aging report, Beeline and outside vendors and diligently completed all assigned tasks, working overtime as needed.
  • Computed Data Reports - Provided required weekly, monthly and quarterly reports Omni aging reports to maintained aging Omni items in the Local Health Plan workbasket and worklists under 10% and sending weekly update and communication to all departments across the plan.

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Resume Overview

School Attended

  • Universidad Monsenor De Talavera
  • Gold Coast

Job Titles Held:

  • Customer Service Supervisor of Member and Provider
  • Team Lead
  • Senior Customer Service Representative

Degrees

  • Associate of Science
  • Real Estate Associate

By clicking Customize This Resume, you agree to our Terms of Use and Privacy Policy

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