| PROFESSIONAL PROFILE - Highly skilled Call Center Operations/Healthcare professional with 12 years of management experience in: Customer Services Delivery, Call Center Management and Automated Call Distribution ACD Reporting, Quality Assurance and Medicare Managed Care Operations. Highly effective in collaborating with executive management to formulate and implement profitable business strategies to improve customer retention. A proven record of accomplishment of aligning corporate L F policy with regulatory guidelines: through implementation of industry best practices over multiple departments. Major accomplishment include:
- Improved development and performance management standards between 5-15 by diagnosing improvement opportunities, providing effective feedback, coaching, training, professional development, and introduction of compensation plans to reward high-performing individuals
- Services-oriented with 16 years of expert knowledge of government regulation of Medicare Part A, B, C and D , Medicaid, and HMO, HIPAA Compliance and Marketing/Sales
- Effectively used Call Center Technology to improve proficiency productivity by 25
- Enhanced service levels through extensive work flow analysis and refinement
- Restructured the Call Center to maximize focus on first call resolution and retention by 15 in 6 month period
PROFESSIONAL EXPERIENCE Confidential - Manager of Research Analysis
- Manager of Member Provider Services
- Operational Call Center Manager
Responsibilities: - Administered solutions, and services to enhance service quality, and member retention, operational effectiveness, and technical service
- Minimized risk, and developed business cases to support new technology, service, and operation
- Provided strategic support to Customer Service department, by creating, validating, analyzing and maintaining various Call Center related reports
- Lead the call center best practices process development/ improvement and managing organizational change and developing employees- training materials for the new processes, technologies and work with vendor to implemented management, quality assurance to ensure service levels are satisfied
- Responsible for managing Customer Services, Membership Accounting, Transportation, Member Insight, Distribution Sales Unit, Mail Room, Front Desk Receptionist and Outsource Call Center of 5O seats
- Oversaw activities and development of 10 Team Leads supporting 100 customer service representatives
Achievements - Exceeded the company benchmarks of 90 closure rate of open Call Tracking Inquires
- Restructured the Call Center to maximize focus on first call resolution and retention by 15 in 6 month period
- Managed outreach campaigns to Medicaid membership and contracted healthcare plans of more than 800K members across 15 states
- Collaborated with call center vendor teams in addition to other internal business units to establish and reinforce excellent relationships between vendors and the organization
- Exceed call metrics goals and government regulations by 5 , while managing a high call volume 400,000 calls per annum
- Reduced call volume between 5-10 by developing an Automated 24 hours Eligibility IVR system for provider inquiries and created new efficient call flows based on new lines of business
- Implement call routing configuration, set up IVRU prompts, wrote IVR scripts
- Developed call center metrics and reporting that provided strategic overviews of business operations in the areas of key performance indicators KPI , quality assurance, and employee productivity metrics and coaching improvement strategies
Confidential Customer Service Supervisor Directed and monitored daily activities and managed staffing and forecasting requirements of a 25 station call center, including supervisory development plans, quality assurance, process improvement, managed performance metrics, coached improvement strategies, and conducted feedback Confidential - Manager of Quality Assurance/Trainer
- Utilization Management Intake Coordinator
- Medical Claims Eligibility Representative
Confidential - Claims Processor
- Senior Claims Clerk
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