provider service team lead resume example with 10+ years of experience
JessicaClaire
Montgomery Street, San Francisco, CA94105(555) 432-1000, resumesample@example.com
Professional Summary
Innovative supervisor seeks career position offering opportunities for new professional and personal challenges. Self-starter with a positive, can-do attitude who is driven to learn, improve and succeed. I offer up over 17 years of progressive experience in the Healthcare industry.
Education and Training
Expected in 2002 to to Associated | Applied Science for Information TechnologyTarrant County College, Ft. Worth, TXGPA: 2002 Tarrant County College Ft. Worth, TX * Associated Degree in Applied Science for Information Technology.
Expected in 2009 to to Bachelor of Science | Public Affairs and Community ServicesUniversity of North Texas, Denton, TXGPA: 2009 University of North Texas Denton, TX * Bachelor of Science Degree in Public Affairs and Community Services
Expected in 2012 to to Master of Business Administration | Healthcare AdministrationTexas Woman's University, Denton, TXGPA: 2012 Texas Woman's University Denton, TX * Executive Master of Business Administration Degree in Healthcare Administration
Skill Highlights
Critical thinking proficiency, conflict resolution, claims analysis and review specialist, staffing management ability, staff training and development, cultural awareness and sensitivity, Microsoft Office, Applications, Quickbase and SharePoint.
Professional Experience
01/1 to CurrentProvider Service Team LeadHearst Communications | Indianapolis, IN, * Manage a team of five Claim Data Reporting analyst. * Site Lead back-up. * Manage reporting for Joint Claim Administration organization. * Generate reports daily, weekly, monthly and yearly for Claims Operations. * Analyze and review reports for process improvement. * Create monthly presentations for the Executive leadership team. * Create databases to store and update data. * Create custom reports when requested. * Managed one Provider Claim and Reconsideration analyst, one Rates analyst, two Quality Analyst, five HMO claim processors and 12 Traditional claim processors. * Site Lead back-up. * Maintain financial Key Performance Metric of 99%. * Maintain total claim accuracy Key Performance Metric of 92%. * Maintain pay incidence Key Performance Metric of 97%. * Actively maintained up-to-date applicable state and Federal laws, regulations and Healthcare Reform Act mandates. * Regularly evaluate employee performance, provide feedback and assisted, coached and disciplined staff as needed. * Organize and led bi-weekly staff meetings. * Provide thorough supervision for day-to-day operations for department. * Resolve escalated claim issues. * Pull daily inventory reports for analysis and to assign work. * Produce and analyze reports for the function. * Resolved complaints and appeals for members. * Maintain and exceed production goal of four cases per day. * Assist Provider Complaint and Appeals segment when needed. * Worked Complaint and Appeals via the Electronic Correspondence Handling. * Maintained and exceeded 95% quality Key Performance Metric. * Managed 15 Traditional, four Health Maintenance Organization, Flex Team Members and one Quality Analyst. * Lead person for PROSCAT team. * Maintained Electronic Correspondence Handling System turn around time at the 91% metric. * Pulled backlog reports daily and distribute work to team and alternates. * Worked Electronic Correspondence Handling System worktasks to assist team when needed. * Ensured team met the call center's Key Performance Metrics in addition to Correspondence Key Performance Metrics. * Resolved escalated provider calls. * Managed incorrect claim rework referrals between National Accounts and Provider Service. * Managed 17 Customer Service Representatives and one Quality Analyst. * Conducted division system trainings when needed. * Back-up trainer for classes aligned to Provider Segment when needed. * Back-up for manager in her absence. * Managed incorrect claim rework referrals between National Accounts and Provider Service. * Supervised PROSCAT team.
01/1 to 01/1Claims ProcessorAetna US Healthcare | City, STATE, * Managed and Facilitated new hire claims and customer service training classes. * Conducted re-training and refresher classes for Claims Processors and Customer Service Representatives. * Mentored existing employees who were not meeting Key Performance Metrics. * Attended all Supervisor meetings to stay abreast of training needs. * Contact Liaison for Plan Sponsors to handle escalated issues. * Supervisor back-up for 18 employees in her absence. * Mentored new trainees when released to the floor. * Divisional trainer for the entire division. * Processed Managed Care, Traditional Choice and Open Choice medical and hospital claims in the Managed Choice system and Automated Claims Adjudication System. * Processed Managed Care, Traditional Choice and Open Choice medical and hospital claims in the Managed Choice system and Automated Claims Adjudication System. * Supervisor back-up for 19 employees in her absence. * Back-up Customer Service Representative. * Conducted mini-trainings when needed.
Presentations
Create monthly presentations for the Executive leadership team
Skills
Claims, National Accounts, Customer Service, Receptionist, Retail Sales, Operations, Health Maintenance Organization, Correspondence, Healthcare, Bi, Business Intelligence, Employee Performance, Hmo, Inventory, Cases, Exceed, Accounts And, Metrics, Team Lead, Customer Service Training, Training, Managed Care, Customer Service Representative, Processor, Data Reporting, Databases, Process Improvement, Maintenance, Liaison, National Account, Healthcare Industry, Microsoft Office, Microsoft Sharepoint, Ms Office, Self-starter, Sharepoint, Staff Training, Staffing, Public Affairs
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