A proactive, result-oriented, passionate, patient, customer service representative with extensive experience for 12 years in:
•Training and developing customer service teams
•Customer Service inbound and outbound calls
•Strategic planning and implementing updated policies and procedures
Position Purpose: Responsible for developing and conducting a variety of training programs and/or auditing tools for thefrontend, Vertex, PLS, Mailroom and OIC Ferguson claim center
• Function in the capacity of the Frontend facilitator expert for Ferguson Claims Center • Conducted over 80 training sessions for 150 new hire and current reps for Vertex, PLS, Mailroom and OIC Ferguson claim center.
• Facilitated in person training for Vertex in the state of AZ and NY • Facilitated virtual trainings for OIC in the state of CA and GA
• Implement work processes for staff to mediate known claims issues and ensure providers receive guidance towards resolution
• Identify, select, and develop and conduct appropriate training programs, including the selection or design of appropriate training aids bridge staff knowledge gaps
• Assist with revisions to policy and procedures and/or work process development
• Maintain records of training activities and training employee progress
• Perform quality reviews for new hire classes, providing clarification and direction to reps as necessary
• Assist in auditing work performed by staff and present findings and recommendations for areas of improvement to management
• Partner with frontend departments and oversight resolution to department concerns and issues.
• Manage attendance and performance of up training and new hire staff.
• Coordinate documentation, tracking and resolution of all training issues.
• Provide expertise and research in both verbal and written for claims inquiries issues.
• Scheduled and taught in class and online courses to increase learning opportunities.
Position Purpose: Serve as a liaison between Customer Service Representatives CSRs), management and other various departments. Resolve OIC staff inquiries via in office with verbal and written correspondence in a timely and appropriate manner.
•Customer service/Claims Liaison for OIC Department
•Subject Matter Expert for the automation project working directly with the business partner Cognizant
•Subject Matter Expert for OIC and Omni to ensure new hires and floor reps are following process and procedures as directed.
•Maintain performance and quality standards based on established call center metrics including turn-around times.
•Organize work assignments from the Access Database for OIC
•Send out stat reports for CRM, Database, and OMNI as needed
•Document all activities for quality and metrics reporting through the Customer Relationship Management (CRM) application
•Department Trainer: Facilitate New Hire OIC Training within Customer Service as well as up-train customer service reps.
•Coordinate the day-to-day work functions, acting as a “go to” person and investigating and resolving complex issues.
•Facilitated Amisys Training to Health Net CA Team
•Facilitate Up-Training to Reps when information is updated
•Respond to inquiries via CRM, Database, Omni, and written correspondence within established timeframes utilizing current reference materials and available resources
•Provide assistance to other departments within the company with system issues and work process issues
•Perform quality reviews for new hire classes as well as OIC department Reps, providing clarification and direction to reps as necessary
•Access, review, and update Amisys as applicable based on information obtained through investigational research
•Investigate and resolve complex claims matters in coordination with health plan and/or corporate departments.
•Conduct appropriate auditing processes(Spot checks once a week)
•Provide first call resolution and “own the process” by working with appropriate internal/external resources and ensure the closure of all inquiries.
•Initiate change requests to resolve system configuration questions impacting claims processing; review and test results
•Collaborate with other departments on cross functional tasks and projects Maintain performance and quality standards based on established call center metrics including turn-around times.
•Respond to and resolve on the first call, customer service inquires and issues by identifying the topic and type of assistance the caller needs such as benefits, eligibility and claims, financial spending accounts and correspondence
•Provide inquiry updates on new system implementations for special projects
•Help guide and educate customers about the fundamentals and benefits of consumer-driven health care topics to include managing their health and well-being by selecting the best benefit plan options, maximizing the value of their health plan benefits and choosing a quality care provider
•Intervene with care providers (doctor's offices) on behalf of the customer to assist with appointment scheduling or connections with internal specialists for assistance when needed
•Own problem through to resolution on behalf of the customer in real time or through comprehensive and timely follow-up with the member
•Research complex issues across multiple databases and work with support resources to resolve customer issues and/or partner with others to resolve escalated issues
•Up-train new procedures/Floor support
•Provide education and status on previously submitted pre-authorizations or pre-determination requests
•Meet the performance goals established for the position in the areas of: efficiency, call quality, customer satisfaction, first call resolution and attendance
•Performed general office duties, such as filing, answering telephones, and handling routine correspondence. Complete bank deposits
•Receive, record, and bank cash, checks, and vouchers.
•Prepared bank deposits by compiling data from cashiers, verifying and balancing receipts, and sending cash, checks, or other forms of payment to banks.
•Delivered inter office mail
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