In this role, I was able to leverage my expertise in Medicare, specifically Medicare Part D, to conduct QA audits and reviews of claims under appeal, as well as resolve grievances and complaints from members. Claims are often denied for a variety of reasons, and in this role I conducted research, including extensive clinical and policy interpretation, to assist members in determining the root cause of the issue. In the first few months, I have achieved the following:➟ Our audit,… Show more In this role, I was able to leverage my expertise in Medicare, specifically Medicare Part D, to conduct QA audits and reviews of claims under appeal, as well as resolve grievances and complaints from members. Claims are often denied for a variety of reasons, and in this role I conducted research, including extensive clinical and policy interpretation, to assist members in determining the root cause of the issue. In the first few months, I have achieved the following:➟ Our audit, research and response to members must be completed within 30 days. Despite the large learning curve and extensive research that many cases require, I have met or exceeded this goal.➟ I have learned several new technology tools and systems including Dynamic Healthcare Systems, FirstTrax and Laker. Show less

After a successful 2 years as a representative selling Medicare, Medicare supplements, individual major medical, individual dental and vision and Medicare prescription drug plans Humana, I was asked to take on the QA role. It is my job to evaluate, monitor, coach and train representatives to comply with all policy and regulations while providing the best possible customer service and ensuring each sales experience was productive. Using a combination of call monitoring – both side-by-side and… Show more After a successful 2 years as a representative selling Medicare, Medicare supplements, individual major medical, individual dental and vision and Medicare prescription drug plans Humana, I was asked to take on the QA role. It is my job to evaluate, monitor, coach and train representatives to comply with all policy and regulations while providing the best possible customer service and ensuring each sales experience was productive. Using a combination of call monitoring – both side-by-side and remote, monthly training, communication programs and mentoring, I positively impact our team.Highlights of my contributions include:➟ My efforts have boosted revenues, maximized sales opportunities and improved conversion rates. By ensuring compliance, I am protecting my company’s reputation and assisting to mitigate risk.➟ Using metrics analysis, I have been able to identify underperforming representatives and determine the root cause of their performance issues. By providing targeted feedback and coaching I have been able to play a key role in boosting low-performing associate conversions from 16.6% to as high as 25.2% within one week of working together.➟ Because I am known as a team player who constantly seeks process improvement opportunities, I was asked to be part of team of QA specialists from all 6 call centers nationwide to create standard QA evaluation process and assessment checklist. Once implemented, these procedures are intended to ensure consistent standards company-wide. Show less

Although I had previously worked in the insurance industry, this was my first position marketing and selling insurance. Though I met my goals and was well-regarded as a sales rep, I found that my true skill was in compliance, quality and customer relationships. I truly enjoyed finding a way to connect with each customer and quickly assess their needs in order to present targeted benefits for Medicare, Medicare supplements, individual medical, dental and vision plans. I treated each person with… Show more Although I had previously worked in the insurance industry, this was my first position marketing and selling insurance. Though I met my goals and was well-regarded as a sales rep, I found that my true skill was in compliance, quality and customer relationships. I truly enjoyed finding a way to connect with each customer and quickly assess their needs in order to present targeted benefits for Medicare, Medicare supplements, individual medical, dental and vision plans. I treated each person with respect, courtesy and professionalism – no matter the situation. I was often selected to work on special programs and projects. It was the following accomplishments that led to my promotion to the QA team:➟ I was ranked #1 of 300 agents for my quality assurance audit scores. I consistently averaged 99.6% on my audits which evaluated policy and regulatory compliance and customer service. Because of my scores, I was often asked to mentor new or underperforming representatives. My peers recognized me as the go-to person to consult with them about issues that arose during their customer interactions. Show less

This was my first position in the insurance benefits industry. I supported the administrative and office operations for a team of 10 insurance sales agents. Though I was not selling, I supported them in gathering all their marketing materials, scheduling their presentations and serving as the first point of contact for any customer issues. My team marketed and sold supplemental insurance plans such as life, cancer, hospital, indemnity and disability to large employers with up to 500 employees… Show more This was my first position in the insurance benefits industry. I supported the administrative and office operations for a team of 10 insurance sales agents. Though I was not selling, I supported them in gathering all their marketing materials, scheduling their presentations and serving as the first point of contact for any customer issues. My team marketed and sold supplemental insurance plans such as life, cancer, hospital, indemnity and disability to large employers with up to 500 employees during their open enrollment periods. I often handled confidential and sensitive HIPAA and Privacy Act protected information with discretion. Show less

After spending several years providing administrative support to Ryland’s executive leaders, I was promoted into this role where I managed the planning and scheduling of the company’s 2-year training calendar. I planned and coordinated all aspects of 15 annual week-long training events for up to 120 personnel. From start to finish, I coordinated events to include research and selection of venues, negotiation of contracts for meeting space, food and beverages and coordination of travel… Show more After spending several years providing administrative support to Ryland’s executive leaders, I was promoted into this role where I managed the planning and scheduling of the company’s 2-year training calendar. I planned and coordinated all aspects of 15 annual week-long training events for up to 120 personnel. From start to finish, I coordinated events to include research and selection of venues, negotiation of contracts for meeting space, food and beverages and coordination of travel arrangements and itineraries to bring in sales agents from nationwide locations. I had a budget that I had to operate these programs within and I reviewed, approved and processed all invoices and analyzed all costs and expenses to optimize the funds. Show less