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specialty program manager resume example with 11 years of experience

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Jessica Claire
Montgomery Street, San Francisco, CA 94105 (555) 432-1000, resumesample@example.com
Career Overview
Highly enthusiastic customer service professional with 18 years client interface experience. A Dedicated Customer Service Representative motivated to maintain customer satisfaction and contribute to company success.
Core Strengths
  • Seasoned in conflict resolution Axys, Switch Manager, 10-key Touch, Rumba, CCNET, PC-IBM, Microsoft word ,Excel, Outlook,Salesforce and spreadsheet
  • Strong organizational skills Courteous demeanor
  • Sharp problem solve
  • rEnergetic work attitude
Accomplishments
Customer Service
  • Researched, calmed and rapidly resolved client conflicts to prevent loss of key accounts.
Product Sales
  • Cross-sold services at a rate of 30%, upgrading customers to different plans and product packages.
Work Experience
2012 to 04/2014 Specialty Program Manager Tmx Finance Family Of Companies | Richardson, TX,
  • Responsible for ensuring required referral and clinical data is collected, completed and communicated per URAC policies and procedures.
  • Ensure that we meet the compliance with regulatory and professional standards.
  • Works in collaboration with multiple departments and services internally and externally to identify and implement best practices patterns across the continuum that provide optimal patient care, efficient resources utilization and top performance for patient satisfaction and quality performance.
  • Provide outstanding customer service to all external and internal customers.
  • Develops and maintains effective relationships through effective and timely communication.
  • Takes initiative and action to respond, resolve and follow up regarding customer service issues with all customers in a timely manner.
  • Answer incoming/outgoing referral calls Responsible for ensuring required referral and clinical data is collected, completed and communicated per URAC policies and procedures.
  • Ensure that we meet the compliance with regulatory and professional standards.
  • While working in collaboration with multiple departments and services internal.
  • Assuring high quality and innovative services are provided to program participants.
  • Using a variety of techniques that result in positive outcomes for the participants.
  • Developing and implementing a vision for a successful program.


    Prior authorization Rep: 01/11-12/11

  •  Answer calls from pharmacy, physician's office and insurance          carriers.
  • Medicaid, Medicare and standard insurance carriers).
  • Accurately enter required information into computer database.
  • Review prior authorization request and match against insurance forms while following established procedures for referring request for further review.
  • Follow up with pharmacy and update precertification numbers, denial information, etc.
  • Once obtained, document and update database.
  • Verify provider information prior to sending documentation.
  • Manage a work queue of 50-150 PA's daily.
06/2007 to 07/2009 Member Service Rep Ken Garff | Ogden, UT,
  • Excelled in exceeding daily credit card application goals. Developed highly empathetic client relationships and earned reputation for exceeding sales goals. The daily handling of financial inquires and issues.Cross-trained and provided back-up for other customer service representatives when needed.
  • Educating members of new products and services and offer recommendations to fit their needs.
  • Processing loan applications for new or existing members.
07/2005 to 06/2007 Customer Service Representative Service Electric Cable TV | City, STATE,
  • Assist subscribers with Billing issues, technical troubleshooting and educating on new products and services.
  • While updating subscriber's digital equipment and modem services.
  • Updating monthly delinquent notices. Managed quality communication, customer support and product representation for each client.Earned “Top Seller” for two consecutive quarters in 2006. Earned “Top Seller” for two consecutive quarters in 2007.
04/2003 to 04/2014 Sales Associate Weichert Realtor | City, STATE,
  • Prepared and sold broad range of customized merchandise to individuals and commercial accounts. Negotiate the sale of real Property Educate buyers and sellers.
  • Conduct current marketing strategies with preparation to buying and selling of Real Property.
  • Assist Buyer's and Seller's with Home Inspection, Water Testing and Underground Oil tank.Achieved high sales percentage with consultative, value-focused customer service approach. Computed accurate sales prices for purchase transactions.
Educational Background
Expected in Present to to | Sociolgy Centenary College, Hackettstown, NJ GPA:
Continuing education in Social WORK
Expected in 8/10 to to | William Paterson University, , GPA:
Expected in 10/97 to to Certified Medical Assistant CPR Certification Hospice Volunteerism / Appreciation Award | Bergen County School EMT, Paramus, NJ GPA:
Skills
10-key Touch, Billing, CPR, customer service, database, documentation, financial, forms, I insurance, marketing strategies, Excel, office, Outlook, Microsoft word,  Rumba, selling, spreadsheet,  Multi-tasking Professional and friendly Careful and active listener Cash handling

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Resume Overview

School Attended

  • Centenary College
  • William Paterson University
  • Bergen County School EMT

Job Titles Held:

  • Specialty Program Manager
  • Member Service Rep
  • Customer Service Representative
  • Sales Associate

Degrees

  • Certified Medical Assistant CPR Certification Hospice Volunteerism / Appreciation Award

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