Utlization Management Representative III Resume Example
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UTLIZATION MANAGEMENT REPRESENTATIVE III
Summary
Customer service driven team lead with proven management abilities and effective interpersonal skills. Constantly appointed to manage and coach in building relationships to maintain long term strengths for the team. Adept at managing concurrent objectives to promote efficiency and influence positive outcomes.
Skills
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Experience
Utlization Management Representative III / Anthem, Inc. - Elizabeth , NJ07/2016 - Current
- Developed, implemented and monitored programs to maximize customer satisfaction and manage on-site customer service representatives.
- Routinely prepared and evaluated reports to identify problems and areas for improvement.
- Responsible for providing technical guidance to UM Reps who handle correspondence and assist callers concerning contracts and benefits.
- Established performance targets for staff members and tracked the results.
- Assisted in hiring and training new employees.
- Effectively communicated with other employees and upper management to ensure complete care of members.
- Assists management by identifying areas of improvement and willing to take on new projects as assigned.
- Handles escalated and unresolved calls.
- Mentors new employees as a preceptor.
- Ensures UM Reps are directed to the appropriate resources to resolve issues.
- Responsible for running daily and weekly departmental reports.
- Lead and liaison on the inbound project.
- Assists management with reviewing resumes and interviewing potential candidates.
- Exemplifies behaviors embodied in the 5 Core Values of Anthem.
- Monitors employee performance to determine areas of success and improvement using Verint recording.
- Assisted in implementing and training UM representatives on the new Macess and Genesys applications.
- Supervised a crew of 30 employees.
- Monitors adherence in Pulse and works collectively with Work Force Management to ensure time management of employees.
Utilization Management Representative II / Cowan Systems - Baltimore , MD01/2015 - 07/2016
- Delivered fast, friendly and knowledgeable service for routine questions and service complaints.
- Met and exceeded productivity targets by handling every interaction with top-notch customer service.
- Evaluated customer account information to assess current issues and determine potential solutions.
- Upheld privacy and security requirements established by HIPAA guidelines.
- Documented conversations with customers to track requests, problems and solutions.
- Worked with managers to develop service improvement initiatives.
- Maintained calm, friendly demeanor with upset customers to de-escalate stressful situations.
- Responsible for contacting members via Avaya outbound dialing system to update heath information utilizing the Health Risk Assessment and tasking those members to appropriate queues.
- Knowledgeable of Facets and Care Compass regarding member eligibility, HIPAA and designated representatives.
- Acts as a liaison between Medical Management
Customer Service Representative / Cowan Systems - Burlington , NJ08/2012 - 01/2015
- Provided information to members regarding coverage benefits, locating providers within the network, verified status of authorizations and other concerns.
- Collaborated with colleagues to discuss market information and strategies.
- Acknowledged customer issues and resolved their problems quickly and efficiently.
- Served as a liaison for multiple departments.
- Responsible for handling high volume of telephone calls within certain time restrictions.
- Served as a subject matter expert and trainer for new employee
Customer Service Representative / QVC - City , STATE01/2006 - 08/2012
- Assisted customers' inquiries and complaints.
- Educated customers about product options to exceed their experience.
- Managed escalated call backs and monitored CMS for average talk time.
- Mentored new employees as a preceptor and provided appropriate coaching.
- Assessed customer needs based on words and tone of voice to determine the best action to take for customer retention.
- Audited call center representatives to ensure quality service was being provided.
- Directed inbound calls to appropriate departments or management as needed.
- Provided customer resolution by listening to the customer's problem and offering several solutions from which the customer could choose.
Education and Training
Norfolk State University - City, State05/2005Bachelor of Arts: Hospitality Administration And Management
Tidewater Community College - City, State12/2003Associate of Applied Science: Culinary Arts
Indian River High School - City, State06/2001
Accomplishments
April 2018
Selected By Manger to participant in Anthem Aspiring Leadership Fundamentals Program.
September 2016, June 2018, March 2020
Nominated and received the Values in Actions award.
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Resume Overview
School Attended
- Norfolk State University
- Tidewater Community College
- Indian River High School
Job Titles Held:
- Utlization Management Representative III
- Utilization Management Representative II
- Customer Service Representative
Degrees
- Norfolk State University -
City,
State
05/2005 Bachelor of Arts : Hospitality Administration And Management
Tidewater Community College - City, State 12/2003 Associate of Applied Science : Culinary Arts
Indian River High School - City, State 06/2001
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