PROVIDER CUSTOMER SERVICE REPRESENTATIVE SUPERVISOR
More than 7 years' successful experience in customer service and support with recognized strengths in account maintenance, problem-solving and trouble-shooting, Customer staff support, and planning/implementing proactive procedures and systems to avoid problems in the first place. Possess solid computer skills. Excellent working knowledge using; Supervisor CIMS, Facets, Microsoft Excel, WordPerfect, Microsoft Word, Plan Connexion, Avaya, Workforce Management, Verint, Share Point, Doc Creation, Quality Management. Ability to train, motivates, and supervises customer service employees. A team player, acknowledged as "Total Quality Customer Service Professional." Develop plan, conduct audits and variance analyses, process payroll and payroll tax reports and filings, and maintain/update accurate inventories.
Types 40 WPM
Advanced oral and written communication skills
Advanced computer skills
Provider Customer Service Representative SupervisorJanuary 2011 to January 2014 Blue Cross Blue Shield of La - Baton Rouge, LA
Maintained #1 Customer Service Team in the Company from April 2013 - March 2014.
Coached and monitored staff quality, adherence and attendance to ensure best results and rankings.
Received top award for Coaching Others for Top Performance on December 10, 2010.
Received top award for Accelerating Team Productivity on December 14, 2011.
Received top award for Managing the Performance of Others on December 14, 2011.
Proactive planning led to notable increase in morale in all departments.
Passed customer satisfaction survey, by maintain and rendering great customer service to our customers.
Work with 31 provider services representatives covering 50 states, responsible for more than 35,000 individual members, other Blue Cross Plans and Providers.
Training and developing staff, coaching and etc.
to ensure team goals were met.
Quickly and effectively assist in solving customer challenges.
Administered all HR functions, including hiring, terminating, conducting performances reviews and setting performance standards.
Approving work schedules, assigning and directing daily work load.
Maintain quality control/satisfaction records, constantly seeking new ways to improve customer service.
Serves as the Provider Service expert of assigned staff and maintained thorough knowledge of required lines of business, changes to recent laws and regulations, HCPCS coding, ICD9 codes, medical terminology, computer systems, claims policies and procedures to ensure consistency in delivery of excellent customer service.
Monitors the CentreVu phone system to find resolutions or develop preventive measures to ensure maximum efficiency or resources.
Monitors the aging process on all action and task to ensure compliance with MTM and Corporate guidelines were met.
ITS Claims Adjustment LeadJanuary 1998 to January 2011 Blue Cross Blue Shield of La - Baton Rouge, LA
Served as work Group Leader in the unit.
Handled cases which was more complex and required special expertise.
Demonstrated proficiency in appropriate line of business and applicable systems to ensure accurate information is being communicated to support staff, internal and external customers in accordance with policies, procedures and guidelines.
Conduct department training and coaching for process, procedures and benefit claim adjudication.
Monitor, track and distribute department daily inventory.
Identified and respond to applicable personnel regarding system issues to ensure timely claims adjudication.
Revised manuals to ensure accurate process and compliance with relevant policies, procedures and guidelines, Researched Subrogation and Workers Compensation cases, reviews documentation to determine who is liable.
Research COB information, reviews, and updates, local or national systems to ensure accurate information.
Manually records the savings accumulated during processing of assigned claims.
Request refunds due to claims overpayments during process.
Process deferrals FEP/COB suspended listing by manually coordination contract benefits to ensure claims are processed correctly.
Stanley High School2014Portland, OR High School Diploma:
Membership of the Students' Council
Recipient of Award of Excellence for performing all duties diligently and enthusiastically for the General High School Project.