SUMMARY:

• Accomplished Operations and Customer Service Manager with over 15 years’ experience directing high performing, client focused customer service and call center operations.
• Demonstrated ability to lead, coach and develop effective teams; seeks continuous improvements to provide excellent customer service and increase competitive edge.
• Skilled in quality monitoring, and managing KPIs, reporting tools and technologies, customer center applications, and workforce management tools.
• Experienced with health insurance, Medicare, Medicaid, TPA, Claims, Enrollment, Retention, Sales and other related services. Bilingual in English and Spanish.

TECHNICAL SKILLS:

Microsoft Word, Excel, PowerPoint, Access, Outlook; Proven Coaching/Motivation, Interpersonal/Negotiation, & Decision - Making Skills

PROFESSIONAL EXPERIENCE:

Confidential

Director Call Center Operations

Responsibilities:

• Responsible for the successful operation of Confidential call center. Managed daily inbound and outbound calls on Customer Service, Retention and Sales for Medicare, Medicaid and Private Insurance Plans.
• Responsible for the growth and profitability of our Medicare and Medicaid population.
• Responsible for selling Confidential products and Services.
• Responsible for staffing and operations, customer services, developing and implementing product and service standards.
• Responsible for the strategic planning and execution of all call center operations
• Manage and lead the processes for continuous improvement of the overall customer experience
• Proven experience managing metrics, ensuring customer satisfaction, and reporting statistical performance levels related to call center
• Engaged in leading and inspiring their team in developing and documenting best practices in the performance of all duties and responsibilities
• Highly visible in their role to enhance employee engagement, service levels, knowledge, skills, and morale.
• Design motivational contests, awards, and incentive plans.
• Review Monthly Quality Assurance Observations, coach and develop accordingly.
• Managing employee attendance and Key Productivity Indicators.
• Create, analyze and offer solutions on monthly productivity and marketing reports results.

Confidential, Miami, FL

Operations Manager

Responsibilities:

• Managed daily operations of a National and International Travel Insurance Service Center. Oversee the Travel Assistance Coordinators Department, Claims, Provider Services, Policy Administration and up to 50 team members, which receive and process emails and support incoming and outgoing calls.
• Responsible for the technical and operational functions of the Miami Confidential Service Center including compliance with company standards and industry best practices.
• Establish business plan with goals, objectives, policies and procedures to assure compliance to best practices, claims management services standards, state regulations, and client service requirements.
• Monitored management reports relating to office performance, open cases, accrual and payment reports.
• Ensured consistent delivery of quality services including direct operational responsibility of the Service Center and Claims Department. Responsible of adjudicating and processing over 10 million dollars in claims per year.
• Effectively communicate operational issues, results and plans of the Miami Operations, usually accomplished through attendance at various leadership meetings held throughout each month or quarter.
• Designed and implement measures to drive productivity and improve customer service and loyalty, leading teams through trainings, meetings, monthly reviews, and performance goals/evaluations
• Develop and manage effective working relationships with appropriate departments, Medical Management Team, Finance Department, Executive Team and Global clients.
• Manage the financial results of the Miami Service Center and Claims Department, define strategy and implement the strategy to improve those results.
• Responsible for staffing and training needs, budget preparation, profit and loss management. Direct and/or indirect responsibility for over 50 employees.

Confidential

Operations Manager

Responsibilities:

• Managed daily operations of a National and International Healthcare Third Party Administrators Call Center. Oversee Claims, Provider Services, Policy Administration and Sales team and up to 60 team members, which receive and process emails and support incoming and outgoing calls. Ensured company met client, agent and broker expectations. Assured policies and procedures are followed and goals met. Build client focused culture; coach, develop and motivate staff to provide world class customer service in a fast pace Health Insurance market
• Managed department monthly budget.
• Oversee the creation of custom design health insurance plans that meet client needs.
• Oversee the creation of customize systems to facilitate the enrollment of International Groups.
• Oversee and create Master policies that meet client needs.
• Oversee the enrollment process along with all communications that will go out to clients.
• Resolved service escalations and client issues; review specific escalations to refine internal processes.
• Identify workflow inefficiencies; recommend and implement streamlined/effective processes to improve customer retention rates; collaborate with teams for input and optimal results.
• Designed and implement measures to drive productivity and improve customer service and loyalty, leading teams through trainings, meetings, monthly reviews, and performance goals/evaluations.
• Conducted development programs and drive improvements in customer satisfaction ratings.
• Run and analyzed reports to monitor compliance with company policy and ensure departments are meeting KPI’S.

Confidential, Miami, FL

Operations Manager

Responsibilities:

• Authored the Manager Personal Guide to Customer Service for new Service Managers and wrote, coordinated, and introduced the Customer Service New Hire Training Pilot Program.
• Designed and implemented the Cisco Log in and Out Coding Procedures and Guidelines for Customer Service to improve availability and employee monitoring and supervision.
• Instituted the first Quality Assurance Program for Customer Service.
• Created the employee and manager Monthly One on One program; conducted first Manager Development One on One sessions.
• Developed and implemented Confidential Initiative to improve manager leadership and skills.