Team Leader of Member Services Resume Example
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TEAM LEADER OF MEMBER SERVICES
Summary
Detailed-oriented employee with over 10 years of solid experience in Customer Service in different parts of the Retail, Healthcare and Office Environment; Established dramatic improvement with in all of the affiliated, knowledge of principles and processes for providing customer and personal services. Familiarity of administrative and clerical procedures and/or systems such as word processing, managing files and records, designing forms, and other office procedures and terminology.Seasoned customer service specialist with background in providing advice on diverse customer situations.
Highlights
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Accomplishments
- Researched, calmed and rapidly resolved client conflicts to prevent loss of key accounts.
- Promoted to Call Center Team Lead in a year and a half.
- Key-point person for implementation of any new programs and policies involving the Provider Call Center
- Supervised and initiated the development of the HIPAA Privacy Release Form project
Experience
Team Leader of Member Services02/2014 to CurrentApollo Medical Holdings, Inc.El Monte , CA
- Instructed staff on how to handle difficult and complicated members and providers ·
- Hired, trained, and evaluated associates in various products such as Provider Call Center, Authorizations and Member Services
- Examined and evaluated quality of calls and performance based on Call Center metrics.
- Responsible for daily activities in the member services function for a health maintenance organization (HMO).
- Ensures service representatives follow established policies for addressing member inquiries and meet service quality goals.
- Familiar with a variety of the field's concepts, practices, and procedures.
- Relies on extensive experience and judgment to plan and accomplish goals.
- Assisted supervisor with the coaching and management of the team.
- Point person for the Provider Call Center in New York City region of the Call Center.
- Conducted 10+ Provider Call Center trainings Responds to inquires and member issues concerning Plan benefits on a timely basis.
- Responded to customer inquiries and complaints
Oversees
varies Call Center Projects such as Provider Relations Inbox, Member
Services Letter Log, HIPAA Privacy Release Forms and PCP Request.
Provider Call Center Rep and QHCM Authorizations Associate05/2012 to 02/2014Fidelis Care NYCity , STATE
- Liaison between the providers and the managed care environment to ensure satisfaction.
- Responds to concerns providers have concerning claims, medical and pharmacy authorizations and contract management.
- Served as an advocate for Manage Care members within a managed care environment to ensure their satisfaction with the plan.
- Oriented new members to Manage Care through telephone and live orientation sessions.
- Referred members to Health Services, Behavioral Health and Health Education as appropriate.
- Coordinated with Patient care Coordinators follows up with members who need additional education/orientation about to use Managed Care services.
- Maintained and tracked all member contact in Customer Focus and follows up on cases on timely basis with appropriate departments.
- Understood the overall requirements for Medicaid eligibility, Family Health Plus and Child Health Plus eligibility
- Maintained ongoing communication with provider network participation pharmacies and government managed care representatives.
- Responded to inquires and member issues concerning Plan benefits on a timely basis.
- Made the
necessary decision and effort to retain enrollees so as to achieve and
maintain enrollment at projected levels.
Member Services Representative02/2012 to 05/2012Health PlusCity , STATE
- Responsible for orienting Health Plus members on how to use the plan and provider network appropriately.
- Maintained ongoing communication with provider network participation pharmacies and government managed care representatives.
- Responded to inquires and member issues concerning Plan benefits on a timely basis.
- Made the necessary decision and effort to retain enrollees so as to achieve and maintain enrollment at projected levels.
Education
Associate of Arts: Criminal JusticeJohn Jay College of Criminal JusticeCity, State
Certification in EMT-Basic 2010Emergency Care ProgramsCity, State
Skills
Customer Management / Data Entry / Reliability /
Advanced Medical Terminology / 360º Coaching / Performance Management / Dependability
/ Multi-line Switchboards / Facsimile Machines / IDC-9 IDC-10 codes/ Time
Management / CPT codes/ Medicaid and Medicare Fee
Schudeles / Customer and Personal Service / Cash-handling /
/ Interpersonal Skills/ QHCM and Pharmacy Authorizations
/ Claims
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Resume Overview
School Attended
- John Jay College of Criminal Justice
- Emergency Care Programs
Job Titles Held:
- Team Leader of Member Services
- Provider Call Center Rep and QHCM Authorizations Associate
- Member Services Representative
Degrees
- Associate of Arts : Criminal Justice
Certification in EMT-Basic 2010
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