SUMMARY

Objective: To obtain a position for a motivated, highly analytical business professional with 15 years of client service support, problem-resolution, technical support, workforce management and the ability to decisively multi-task to learn and grow personally and professionally. HDI certified.

Employment Experience

Confidential

Business Support Analyst

• Provide second level technical support for Medicare Advantage and Part D MAPD Plan sponsors and Electronic Submission of Medical Documentation esMD on behalf of the Centers for Medicare Medicaid Services CMS .
• Review, troubleshoot, analyze, evaluate, and resolve inquiries involving file transfers, eligibility, enrollment, Low Income Subsidy LIS , payments, and premiums.
• Accurately document research into entry tracking system, participate in the tracking and management of open issues, and assist in planning for resolution for complex projects. .
• Perform data analysis, research, and investigation for complex enrollment, payment issues, and file/data transfer problems.
• Contribute to Quality Assurance QA by performing peer reviews. Create, edit, and analyze detailed documentation of business systems, business processes, and user needs SOPs .
• Use the following CMS systems: MicroStrategy, MBD, MARx, Mainframe, and Remedy.

Confidential

Consumer Direct Member/Provider Service Representative II

• Effectively administered service to clients' inquiries concerning pre-existing conditions, knowledge of policies and riders, identification of other insurance and coordination of benefits, benefit exclusions, administration of direct pay, credit card payment, debit accounting and other enrollment and billing transactions.
• Provided effective training, coaching, and motivation for Level I associates and acted as a resource for new and existing associate staff. Demonstrated best practices and learned skills to assist the team and department with improved quality, productivity and performance metrics.
• Administered various services to callers within the business segment through telephonic inquiries, written and/or electronic inquiries, and claims adjustments.
• Documented all client interactions, using the Facets integrated health care management system.

Confidential

Client Technical Services Specialist

• Provided timely and efficient phone and email support and resolution for clients.
• Performed triage and basic troubleshooting of hardware and software issues.
• Analyzed software and hardware problems of client users and quickly resolved complex issues.
• Properly documented calls using trouble-ticketing system, FogBugz, and ensured the relaying of clear and precise information to the proper department if escalation was required to achieve resolution.
• Maintained currency, accuracy, and relevancy of information within scope of responsibility, including the reporting of known errors or inconsistencies in the information.
• Complied with and consistently enforced information security and confidentiality policies and procedures.

Confidential

Programmer Analyst II/Business Analyst II

• Assisted External Points of Contact EPOCs , submitters and representatives of health plan employees with access to the MARx and MBD systems.
• Provided support for Individuals Authorized Access System IACS for CMS user account setup, maintenance and processes.
• Worked directly with clients to help them prepare for sending test/production files to CMS and provided file transfer analysis and file inspection.
• Provided IT customer support to Medicare Part D Plans.
• Developed new processes/procedures to provide more efficient customer support to Medicare plans. Participated in JAD sessions and requirements analysis.
• Performed side-by-side monitoring and provided training, coaching, feedback and assistance to help desk representatives to ensure comprehension of policies and procedures for quality.
• Performed triage, data analysis, research and investigation for complex enrollment, payment issues and file and data transfer problems.

Confidential

Child Support Intake Specialist

• Appropriately interviewed clients, collected data, and performed research using Maryland State systems Mainframe, CARES, MABS, and MVA and the Internet to investigate and analyze child support cases.
• Initiated appropriate actions to establish, maintain and enforce support payments for dependent children in accordance with applicable Federal and State laws, rules and regulations.
• Entered applications into database registered child support cases and maintained files.
• Retrieved data from computer systems to answer customer questions. Maintained confidentiality of records and information. Created and produced court documents.

Confidential

Customer Service Representative

• Handled high volume of inbound customer service calls in a fast-paced environment.
• Handled credit and billing inquiries, negotiated past-due payment arrangements, and processed payments for collections customers.
• Enforced company collections and service outage policies in accordance with applicable state laws, rules, regulations and safety procedures.
• Handled emergency service outage and gas leaks, including 911 calls.

Confidential

Customer Service Representative

• Handled high volume of internal and external customer service calls while providing quality, accurate and timely service while adhering to all Sales and Service Standards in a call center environment.
• Used extensive knowledge of all security and verification procedures to answer incoming calls regarding general account information, payments and transfers
• Accurately processed transactions, deposits or withdrawals and provided detailed explanations to account inquiries.
• Performed troubleshooting in problem accounts, ensuring resolution.
• Accessed a variety of programs such as: Microsoft Outlook, Information Fulfillment, cuStar, Criterion, Equifax, NADA e-valuator and Resume.

Confidential

General Business Consultant

• Worked successfully within a quick-paced, high-pressured, inbound billing and service call center environment accessing multiple systems to establish, update and retrieve customer service data while simultaneously negotiating with customers and intra-company personnel to provide necessary resolution.
• Handled requests for installation, disconnection or changes of products and services. Reviewed and analyzed existing business services to provide needs-based recommendations.
• Partnered with software developers in product-testing a new order tracking and billing system, ExpressTrak , before and during implementation. Assisted the developers in accurate data conversion.
• Served as Peer Coach, Management Relief, Takeover, and Team-Based Organization Training Committee member
• Knowledge of Complex Foreign Services Overview, CustoPak, Custoflex 2100 Overview, Toll-free Services, VES Long Distance, ISDN Overview, Verizon Freedom For Business, ExpressTrak, Express Web, SSNS, BOSS, BARS, SOACS, Mainframe systems, One Bill, BSG Referral database, Lotus Notes, SOM, and Workforce Management Systems, AMTS, EMPsx and EWFM..
• Discussed, investigated and resolved disputes, complaints and inquiries regarding services, billing, rates, and policies.
• Educated customers by conducting over-the-phone customer training and provided sales fulfillment material.
• Chosen by management to participate and lead special short and long-term projects, including multi-jurisdictional MD, DC, VA, WVA projects, research and reporting, Workforce Management MD, DC, VA, WVA , scheduling, forecasting, payroll, using EMPsx, AMTS and EWFM.