Reviewing and investigation of claims, grievances and appeals on a high level basis that 1st or 2nd tier customer care could not resolve for Medicare and Medicare advantage customers. Thorough documentation including healthcare benefits packages, medical records and Medicare policies to help maintain healthy customer interactions, verify coverage while gaining revenue with minimal expenses required. Providing both verbal and written communications to customers enrolled in a qualified Medicare or Medicare advantage plan detailing processes used to determine final resolution to inquiries or appeals.

Coordinator for internal and external scheduling of field coordinators assigned to attend and educate retirees auto industry employees enrolled in a Blue Cross Blue Shield Health care plan. Cross referencing GM, FORD AND FIAT Chrysler monthly calendars to not only ensure that a Blue Cross Blue Shield representative would be present at monthly meetings nationwide, but they would be equipped with literature and gifts that promote wellness that matches highlighted benefits and incentives that changed quarterly. Ensuring that internal stock and inventory was up to date, issued to field representatives across the domestic US. Proactively procurement of documentation, literature and supplies readily available to 20,000 retirees that require in person assistance with benefits, claim inquiries and activities promoting wellness for the Medicare Advantage population.

• Assigned to Blue Care Network as a Grievance and Appeals Coordinator reviewing cases sent by the Center for Medicaid Services• Analyze, investigate and expedite inquiries that are complex, sensitive and confidential in nature.• Assigned various other task supporting both individual and commercial grievance teams to increase production• Thorough documentation, timely routing of inquiries to respective departments and compiling all findings in order to support decisions based on issued procedures and guidelines.• Extensive Education on BCN HMO plans, certificates, riders, benefits, and policies in order to make best decisions regarding enrollment, premium payments and service workflow.• Written Communication to both Health Insurance Marketplace and BCN Enrollees detailing all steps and decisions made in order to resolve initial issue and how to proactively avoid reoccurring interruptions in service.• Provide the highest quality response (telephone and written) ensuring accuracy, comprehensiveness, empathy and persuasiveness.

• Assigned to the Meridian Health Care project to provide customer service in call center environment for those who selected Meridian Health as there Medicaid Health Provider.• Answering inbound calls from residents in MI, and IL with questions and concerns about their Medicaid coverage including, but not limited to essential health benefits, change of PCP, requesting ID cards and submitting prior authorizations.• Handling calls within the Service Level Agreement with Meridian to ensure maximum production and reduce wait times for the vastly growing Medicaid population enrolling through state programs.• Following HIPPA guidelines at all times when disclosing PHI with both consumers and providers that need assistance regarding access to care, status of claims, and routing to appropriate department for service.• Actively involved in outbound campaigns promoting HEDIS awareness, assisting in scheduling appointments, and provider follow up to provide feedback on access to care.• Well educated on Medicaid policies in both Michigan and Illinois• Complete and real time documentation of calls for quality review, customer surveys and weekly meetings with team leaders to find areas of improvement

The Customer Logistics Manager is typically dedicated to one logistics account and is responsible for all aspects of operations and account management. The CLM is primarily responsible for the leadership of direct reports as well as the attainment of daily operational goals and objectives within an assigned functional area or account. Ensuring that all drivers are trained and informed of customer expectations, processes and operating procedures. Help build and maintain customer relationships with plant management and supervisors. I assign drivers and place equipment in designated positions based on customer needs. Responsible for transportation and passenger vehicle seats, front consoles, and axles delivering to both Ford and Chrysler assembly lines. I make routine checks on equipment and training matrix to make sure both are up to date.

• Answering inbound calls from Ernst & Young Employees Globally in order to service any technical issues affecting production, conferencing, Tax Advisory and Assurance• Supporting issues with connectivity, databases, remote and VPN Access using various tools that are in adherence with Ernst & Young policies• Troubleshooting Active Directory, Mobile Device Applications, Microsoft Office Suite including Word, Excel, Power point, Lync, Outlook, and Lotus Notes•Assisting End users migrating to the latest versions of software and tools within Windows such as Groove, GAMX, Sharepoint Workspace and eDocs• Quickly and effectively solving customer problems or concerns when trying to access EY networking tools and applications or using EY office materials• Providing accurate information regarding any updates, or changes to EY machines, including Laptops, Printers, mobile devices, • Escalating and dispatching tickets based on inquiry, problem or employee status to the appropriate department.•Well versed in understanding and resolving customer issues while documenting the ticket thoroughly within companies service level agreement

• Efficient dispatch of order to independent contractors and third party courier companies• Determines the most appropriate courier for each individual order that will meet customer requirements• Quickly and effectively solve customer challenges• Communicate any order changes affecting operations to couriers, warehouse employees, and customer service agents• Proactive written and verbal communication to both internal and external customers affected by any changes or delays• Provides real time updates on every order by monitoring traffic, weather and flight delays• Constant communication with Independent couriers, and 3PL logistics staff to ensure service line agreements are met while considering expenses versus revenue. • Monitoring any service failures in order to determine root cause and follow procedures based on agreement with both customer and carrier.• Using several software systems to forecast, track, and document shipment status from start to finish such as AS/400, Vantive 3.0, Qual Com, & RTM• Maintain and build relationships with customers in order to promote long term success and grow revenue.• Accurate Microsoft Excel data entry and formulas to create Service Performance presentations for customer review• Monitoring any service failures in order to determine root cause and follow procedures based on agreement with both customer and carrier.

• Reviewed orders from cellular phone vendors in the Metro Los Angeles to replenish stores and ship out to customers• Approved order request for phones based on credit history, phone activations and store inventory• Up sales and product knowledge of all phones and accessories.• Tracking lost shipments, resolving inventory discrepancies, and Quality Control inspections