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Managed Care Customer Call Center Representative Resume Example

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MANAGED CARE CUSTOMER CALL CENTER REPRESENTATIVE
Summary
Customer Service/Administrative Support Dedicated professional with versatile Operations skill sets. Highly organized, strong team player, detail oriented, and work well under pressure Excel in providing innovative solutions for cost reduction and process/system improvement initiatives that increase efficiencies, improve customer satisfaction and contribute to the bottom line Maintain an unwavering commitment to customer service with the ability to build productive relationships, resolve complex issues and win customer loyalty Key Skills Customer Service Discrepancy Resolution Audit Readiness G/L Processing Problem Solving Report & Document Preparation Records & Database Management Microsoft Office Payroll Processing SAP Bank Rconciliation Workflow Re-engineering Quality Improvement Staff Training Data Entry Assessment
Highlights
Microsoft Word, Excel, Access, PowerPoint, Outlook, People Soft
Experience
Managed Care Customer Call Center Representative
August 2013 to August 2014Company Name － City, State
  • Quickly established a trusting rapport with the company by consistently illustrating a high level of efficiency, intuitiveness, self-reliance, and independency when providing healthcare providers and members with first-rate customer service.
  • Earned a reputation for remarkable patience, attentiveness and responsiveness to members needs with an upbeat and friendly demeanor.
  • Efficiently and consistently adhered to identifying, addressing, and resolving a high call volume from health care professionals and members by accurately collecting sufficient information to understand problems and issues.
  • Assisted on average 845 callers a month with insurance coverage verifications, benefit information and billing inquiries.
  • Inputted and updated member's records such as changes to primary care doctors, addresses, and phone numbers utilizing computerized health plan database Compass.
  • Documented all call interactions thoroughly for accurate tracking and analysis reporting.
  • Quality: Consistently provided the company a monthly average of 96% for superb call quality.
  • Adherence: Consistently exemplified perfect compliance (100%) monthly with company policies.
Reconciliation Specialist
January 2006 to February 2013Company Name － City, State
  • Promoted repeatedly throughout career with the Firm; culminating in a function focused on providing superior customer experiences.
  • Managed a high volume workload within a deadline driven environment; thus earning a reputation for maintaining a positive attitude and producing high-quality work.
  • Resolved an average of 300 inquiries in any given week and consistently met performance benchmarks in speed and accuracy.
  • Led by example: considerate of team members, and approached daily functions with a sense of urgency and clear communication to ensure timely completion of workflow and complex issues.
  • Lead Contact: Served as the primary "go to" individual for escalated inquiries based on reliable follow-through, immediate attention, and exceptional resolution results.
  • Cost Savings: Took ownership of three initiatives that resulted in preventing 789 adjustments and write-offs due to customer and internal errors, saving thousands of dollars.
  • Motivated teams to continuously improve results, providing awareness overviews and feedback to clarify the impact of each employee's work on the team.
  • Quality: Actively participated in constructing, preparing and presenting at Quality-Board meetings; sharing results, and celebrating successes with team.
Administrative Assistant
May 2001 to January 2006
  • Generated monthly/weekly/daily reports for unit cost, productivity, attendance and expenses.
  • Responsible for the daily processing and reconcilement of the department's general ledger accounts, that maintained 100 million dollar entries and balances.
  • Administered and maintained payroll for over 300 Department employees; collaborated with employees across departments, building an in-depth knowledge of Item Processing procedures.
  • Selected to cross-train and provide back-up support in various functions as a result of attention to detail, reconciliation/data entry skills, and strong rapport with team Role Expansion: Provided highly versatile production support to meet changing needs, quickly learning new process transformations, workflows, policies and procedures Team Performance: Trained staff in functions/procedures, decreasing overtime and improving productivity Continuous Improvement: Participated in developing and implementing quality/cost reduction initiatives and process improvement projects.
  • Met monthly with management teams to strategize on improvement opportunities Reporting for Business Strategy: Utilized proficient Excel and Access skills in creating reports (tracking staffing, incentives, training, performance, expenses).
  • Managed attendance records via People Soft Selected Accomplishments & Awards 2014 - Employee of the Month for being a quality all-star and delivering a great customer experience for May 2014 2012 and 2010 - Virtual Wall of Fame Inductee for Outstanding Customer Service to LOB Partners 2011 - Treasure Chest Award from LOB Partner Private Banking for proactive support in researching un-reconciled deposits and assistance in resolving inquiries in a timely manner 2009 - Best Practice ICON Winner (Team) for frequently resolving an extremely high volume of requests within approximately 1/5 of the time required in SLAs 2007 - Best Practice ICON Winner (Individual) for commitment to setting high standards in improving the quality of the Department's work and making a difference in the Customer experience.
Education
Diploma : 1988Murry Bertraum High School － State
Skills
attention to detail, back-up, Banking, billing, Business Strategy, clarify, Continuous Improvement, cost reduction, Customer Service, data entry, database, Fame, general ledger, insurance, meetings, Access, Excel, Outlook, PowerPoint, Microsoft Word, payroll, People Soft, policies, presenting, process improvement, producing, Quality, rapport, reporting, researching, staffing, phone, workflow
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Resume Overview

School Attended

  • Murry Bertraum High School

Job Titles Held:

  • Managed Care Customer Call Center Representative
  • Reconciliation Specialist
  • Administrative Assistant

Degrees

  • Diploma : 1988

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