Summary of Qualifications

• Highly self motivated and determined to overcome obstacles to meet goals and deadlines.
• 6 years experience in health insurance administration, over 3 years in Child Support Services, 2 years in banking, 1 life insurance and annuities, and 1 years in IT environment.
• Dedicated and focused able to prioritize and multi-task to achieve project goals.
• Excellent research skills able to grow positive relationships with clients and colleagues at all organizational levels.
• Computer Skills and System Knowledge: Microsoft Office, Siebel, MHS, IMS, ICS, LMS, TAMS, Centre Vu, Budgets Explorer, OPS, OLAP, Power Play, Vantage, Client, STARS, CRM, CMMA, Novel, Avaya, GroupWise, Connect Wise, Quote Works and many other various systems.

Professional Experience

Confidential

Business Analyst

• Provided data mining and analytic support utilizing Siebel for the SBC business unit.
• Worked in collaboration with the SBC team to identify process and business standard operating procedures.
• Created Summary of Benefits for healthcare groups.

Confidential

Technical Account Manager

• Built customer relationships by meeting new prospects and learning about their business.
• Increased new customer acquisition through networking and prospecting.
• Researched and recommended products and services to new and existing clients.
• Quoted and coordinated all resources, products and services necessary for new and existing customer projects.
• Conducted regular account reviews with clients to demonstrate value of Nextrio services.
• Served as primary point of contact for named accounts to ensure customer satisfaction.
• Maintained precise and timely records of all account activity in customer database.
• Managed IT implementation projects for multiple companies.

Confidential

Operations Analyst

• Planned and conducted data-gathering and analysis projects in support of management planning efforts.
• Compiled and analyzed data on operational procedures, prepared reports of findings and made recommendations.
• Management of databases.
• Provided IT assistance for all contact center staff to troubleshoot system and program issues.
• Served as member of the Management team and provided guidance to upper management and supervisors in relation to improving performance and implementing strategies to become more efficient.

Supervisor

• Managed human resources of 14 assigned staff and performed administrative work required for the operation of the unit.
• Served as project leader for other operations analysts and/or units when required.
• Evaluated performance and program practices of staff for quality assurance as needed.
• Serviced inbound calls for Child Support Service cases for the state of Georgia.

Confidential

Customer Service Representative

• Responsible for servicing and/or processing financial and administrative transactions during the policy lifecycle.

Confidential

Operations Analyst II for Decision Support Operations

• Provided key performance reports for the director and senior executive levels.
• Responsible for obtaining all levels of Operational Performance Data from various sources and managing multiple databases, in order to monitor and manage corporate wide goals and objectives.
• Provided technical expertise for the associations BCBSA Member Touch Point Measure reporting requirements for telephone accessibility metrics, which include Inquiry Timeliness, Abandon Rate, Blockage Rate, and Queue Time.
• Utilized technical knowledge and experience to identify and evaluate issues affecting Private Business Operations and Enterprise level Blockage Reporting.
• Prepared key reports on a monthly and quarterly basis and various ad-hoc reports.
• Participated in the planning and budgeting process by keying budgets into Budget Explorer and utilizing past data to create production, service and budget models for future use.
• Prepared weekly and monthly operational performance reports for executive board meetings including presentational data for the director's presentations.

Confidential

• Performed research of member benefits, provider contracts, network management, and operations to collect data for verification to develop or revise guidelines for the claims processing system.
• Communicated and coordinated with functional areas to build consensus, ensure understanding, generate feedback, and distribute accurate information for the Claims Processing and Customer Service Manuals for NGBU HMO.
• Provided technical expertise and support for projects or project teams i.e., SB1508 Work group, NCQA Site Visit Compliance Workgroup, ACHA, Operations Web Workgroup, Fore help Developers Workgroup, Customer Service Telephone Test Pilot from identification, data collection, analysis, intervention, and implementation.
• Maintained gatekeeper security files for employee access.
• Performed workflow coordination, assisting service associates and administrative functions as backup for the Claims and Customer Service Units.
• Supported the Project Managers work efforts by analyzing, verifying, and collecting data and completed delegated projects in an effective and timely manner.
• Audited grievance files monthly.

Confidential

• Resolved customer and provider inquiries via incoming telephone calls and written correspondence.
• Examined, analyzed, entered claims, processed claims and worked suspense.
• Performed research and effectively made decisions to properly adjudicate claims and inquiries within contract benefits and claims processing guidelines.
• Communicated with Other Party Liability, Finance, Membership and Billing, Provider Relations and Medical to resolve provider and customer inquiries.

Confidential

• Provided service for customers by accepting monetary transactions, verifying documentation, and processing data in the system.
• Filed and maintained records of all currency negotiations received.
• Promoted new accounts, safety deposit boxes, bonds and maintained records of all currency negotiations received.
• Opened accounts, input data, completed credit checks, balanced cash drawer, and main vault daily.
• Supported 21 branches as a support staff representative, which included teller and customer service positions, also provided technical training for new employees.