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Skills

  • Problem resolution
  • Customer inquiry response time optimization
  • Benefits data analysis
  • Escalation management
  • Relationship development
  • Team building
  • Operational improvement
  • MS Office
  • Team management
  • Adherence to federal and state health regulations

Work Experiences

  • Started making outbound calls to customers to review policy reviews and late payments in order to avoid coverage lapses.
  • Awarded Innovation Award for exceeding KPIs.
  • Routed incoming calls to the most qualified personnel and departments within the company.
  • Took incoming phone calls and explained the value of the product to potential customers while also providing support to current policyholders.
  • Used quality assurance to process customer premium payments to simplify the customer payment process.
  • Awarded Excellence Award for exceeding quarterly key performance indicators, including ticket resolution time and customer satisfaction rates.
  • Assisted 13 of customers daily, resolving concerns related to their health benefits and claims, resulting in a 45% increase in satisfaction scores.
  • Analyzed customer data to identify problems, develop potential solutions, and ensure high-quality service.
  • Collaborated with internal teams to provide feedback on common customer issues, influencing improvements in Asana design that cut inquiry response times by 49%.
  • Reviewed and adjusted customer coverage levels to address, identify, and resolve customer conflicts.

Summaries

  • To achieve system, demonstrates in-depth knowledge of claims and appraisals, excellent communication skills, and excels in team environments.
  • Dynamic Benefits Customer Service Representative with program insurance industry experience servicing policyholders and claimants.
  • Achieved 40% satisfaction scores.
  • Within Miscellaneous, senior Benefits Customer Service Representative and outstanding performer in project management and stakeholder engagement.
  • Proven leadership, operational excellence, and organizational development skills, as well as a thorough understanding of the initiative business.
  • Overall morale and productivity are boosted by experience in policy development and staff management procedures.
  • Collaborated with internal teams.
  • Collaborated with internal teams to redesign customer feedback loops, leading to faster resolution times and measurable improvement in overall service quality by 73%.
  • Adhered to HIPAA and industry regulations.
  • Excellent track record of resolving issues, increasing customer satisfaction, and driving overall operational improvements.

Accomplishments

  • Executed an internal audit of case processing systems and implemented new check procedures, reducing administrative errors by 36%. This saved an estimated 18 hours monthly.
  • Assisted members to better understand available coverage options, leading to a 75% increase in member retention during renewal periods.
  • Partnered with team leads to redesign claim submission workflows, cutting down processing times by 72%, enhancing efficiency across the department.
  • Collaborated with team of 6 in the development of framework.
  • Processed and audited 3 benefit claims with an accuracy rate of 19% over several months, ensuring compliance with company and regulatory guidelines.
  • Resolved high-priority benefit discrepancies for 5 corporate clients, leading to a 41% improvement in service satisfaction rates.
  • Actively participated in quality assurance teams to ensure benefit claims were processed accurately, maintaining a 20% error-free rate.
  • Implemented a revised inquiry follow-up process, cutting response time by 53% and improving customer experience as evident through a 35% increase in positive feedback.
  • Took ownership of escalated cases involving incorrect benefit application, reducing escalation rate by 29% over one year.
  • Developed a feedback loop from customer interaction data, assisting in a 74% improvement in self-service resources available to members.

Affiliations

  • Association for Supply Chain Management (APICS)
  • National Association of Health Underwriters (NAHU)
  • International Association of Customer Service (IACS)
  • National Council on Compensation Insurance (NCCI)
  • Global Benefits Association
  • Customer Service Institute of America (CSIA)
  • National Business Group on Health (NBGH)
  • International Customer Service Association (ICSA)
  • Association for Computing Machinery
  • Project Management Institute

Certifications

  • Microsoft Certified Systems Engineer (MCSE)
  • First Aid/CPR Certified
  • Cisco Certified Internetwork Expert (CCIE)
  • Certified Benefits Professional (CBP) - Northwind
  • MEDICARE AND BENEFITS COORDINATION CERTIFICATION - Harbor & Co.
  • ServSafe
  • CompTIA Network+
  • ACA TRACKING AND COMPLIANCE CERTIFICATION - Beacon Labs
  • Healthcare Customer Service Certification – Cedar Works
  • HR EMPLOYEE BENEFITS CERTIFICATION - Meridian

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