Operations Team Lead Supervisor resume example

Expected to self manage (in-office or out) myself on a daily basis while conducting a variety of tasks including but not limited to: Staying Inbound for transferred escalated calls. Managing Individual Ticket Folder, along with Group Ticket Folder(s), for my department, and many other departments depending on need. Attend routine trainings for updates. Adhere and adapt to necessary schedule changes/additions depending on department needs. Create content from scratch for new processes, including Zendesk Ticket Creations, Progression Plan documents, POP processes, Information Guides, and being confident in delivering all content created in group and individual settings. Attending focus groups and providing a voice, an opinion, or idea that benefits the meeting/group and company as a whole. Retain information and be a source of insight to colleagues and peers. Maintain a professional exterior to enhance leadership values to the team and company as a whole. Coordinate with other departments and sites via meetings, video conferencing, or follow up via email to provide conflict resolution and problem solve customer issues on individual and group levels. Attend 1x1's with managements to internalize and adjust to feedback provided for positive and productive outcomes. Provide insight on team dynamics and processes to management (not limited to TL) to improve productivity and morale. Assist and lead new projects provided such as Amazon Pharmacy, High Frequent Callers, Secure Demographic Updates, Red Shipment Notifications... ect. Keeping an open mind and remaining adaptive and flexible to day to day changes based on business needs. Maintain a positive disposition and provide core leadership skills to teammates to ensure we're meeting high performance expectations, including personal key performance indicators. Being available for other departments, or members of management anytime a side or special task is required to be performed on an immediate basis.

Responsible for answering questions/concerns to Humana Medicare Insurance members, their caregivers/relatives, & Medical Providers including but not limited to: Pharmacies, Physcians, Medical Nurses/assistants, Hospitals, and other medical facilities & medical billing offices, while maintaining excellent customer service skills using clear, concise and confident language. Logging each call appropriately and notating calls completely while maintaining a polite and friendly demeanor averaging 35-70 calls taken per day. Managing enrollments & disenrollments under Humana Insurance guidelines in coordination with the Centers for Medicare and Medicaid Services (CMS) guidelines. Authenticating /verifying each caller under HIPAA privacy guidelines. Viewing RX prescription claims in ARGUS/Rx Nova to educate members and/or providers on claim denials, paid claims, reprocessed claims, or RX authorizations. Initiating pharmacy prior authorizations if needed or entering temporary prescription authorizations to result in adjudicated claims. Providing medical claim determinations/sending medical claims over for payment reconsideration if necessary by reviewing through CPT, ICD, and HCPCS codes. Making outbound calls to providers, members or other internal departments regarding customer questions/concerns to prevent repeat calling. Fulfilling mail/fax requests for customer requested documents. As a CRM Super User/Experience Coach (Supervisor): My duties include preforming side by sides, and conducting 1x1 with agents throughout the call floor, to ensure we are meeting all Quality Assurance, Net Promotor Score, Perfect Call Metrics and all other Key Performance Indicators. Provide real time feedback verbally and document all feedback for HR purposes. Open communication with clients to discuss areas of opportunity with call flow processes & system enhancements. Directed/Coordinated multiple trainings for Net Promoter Scores/NPS, CRM Roll-out to sites, and Subject Matter Expert (SME) Support in New Hire Classes. Routinely walking call floor to answer colleague questions regarding their own calls. Managed PILOT programs with recording and logging data for future examination. Supporting senior executives by proactively volunteering/engaging in client based focus groups. Training/coordinating other agents whenever requested. Deliver disciplinary action when applicable and document the evidence within all required company systems. Be available 24/7 via mobile phone and email, for the company, client, or members of my reporting team. Promote company/client incentives to inspire the highest performance from my team members, and ensure active engagement from all employees.