Team Leader Of Member Services Resume Example Fidelis Care NY

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

Team management
Meticulous attention to detail
Persuasive
Management of remote employees
Focused on customer satisfaction
Talent development
Skilled multi-tasker

Proficient in MS Office – Word, Excel spreadsheets, PowerPoint, Windows 10, Vista, XP – Professional, 2000, NT, Facets, Info-view, Lotus Notes, Foresight Clams, IHT Technology, CVS Caremark, Epaces, Salesforce, Workforce Management and Workstation, OnBase Web Client, CTI software proficiency

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 CurrentFidelis Care NYRego Park, NY

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 NYRego Park , NY

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 PlusBrooklyn, NY

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 JusticeNew York, NY

Certification in EMT-Basic 2010Emergency Care ProgramsBrooklyn, NY

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

Resume Overview

Companies Worked For:

Fidelis Care NY
Health Plus

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
Certificationin EMT-Basic 2010

Team Leader of Member Services Resume Example

Resume Score: 100%

Resume Overview

Create a job alert for [job role title] at [location].

Similar Resumes