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TROY E. B.
A Circuit Street Roxbury, MA
SKILLS SUMMARY: Windows , XP, Microsoft Word, Excel, PowerPoint,
Word Perfect ., Customer Service, Problem Solving, Organizational Skills, Nortel PBX Move/Adds/Changes
NetworkHealth Medford MA.
* Oversee daytoday operations for assigned team of Claims Customer Service Representatives CSR&;s in conjunction with the Customer Service Director. Responsible for providing support to staff by researching and resolving all claims related issues with appropriate person/department.
* Provide initial and ongoing training to assigned Customer Service Team. This includes the following areas: member benefits medical & behavioral health, prospective member benefits, pharmacy benefits MedImpact, claim research, provider database, Medicomp all related modules, Call Center metrics and Customer Service.
* Provide direct supervision to of CSR&;s including feedback and coaching to the CSRs via regular oneonone meetings.
* Participate in the development, implementation and improvement of quality processes to provide performance measurement standards for individuals and the department. This includes monitoring and auditing all tasks and responsibilities performed by the CSR&;s. Provide feedback and coaching to the CSRs via regular oneonone meetings.
* Participate in the creation, implementation and review of departmental policies and procedures. Participate in performance evaluations in conjunction with the Customer Service Director.
* Answer telephones in the Call Center on a daily basis in accordance with business needs.
* Operational understanding of Symposium Call Reporting and Call Metric software and the ability to perform basic administrative functions related to reporting and Agent ACD functions.
* Thorough understanding of the Appeal, Grievance and Complaint processes and the corresponding MassHealth regulations.
* Thorough understanding of customer service skills proper telephone etiquette, service techniques and the ability to communicate these skills by training, ongoing education and evaluation.
* Participate in crossdepartmental teams to ensure effective workflow.
* Recognize diversity of customers and Network Health employees and displays acceptance for individual differences, beliefs and values with compassion and understanding.
* Facilitate weekly staff meetings.
Health Management Systems. Charlestown, MA
* Supervisor of eighteen employees answering any questions regarding assignment of cases, and the proper method of determining a case. Also handling any irate calls from members. Conduct interviews, recruit candidates for vacancies.
* Contact employers, and verify health insurance benefit information on behalf of eligible households.
* Determine if households and employer sponsored health insurance benefits meet criteria for Family Assistance: perform benefit matrix if necessary.
* Track status of each insurance investigation and ensure all investigations are completed within MassHealth designated timeframes.
* Maintain accurate case notes of each investigation and enter all relevant information into the PCG case tracking system, and the MassHealth MA system.
* Generate accurate benefit decisions in accordance with the guidelines established by MassHealth.
* Educate households and employers about the Family Assistance program.
* Answer all inquiries involving the Family Assistance program in a friendly and efficient manner.
* Prepare individual logs/reports and cases determined each week.
* Accurately maintain and file all case information required per contract guidelines.
* Prepare additional client reports such as Finance Referrals, Weekly Statistics, MEC Referrals, MSCPA Referrals.
Maximus Boston, MA
User Support Specialist
* Local Area Network LAN Support Specialist related to MSWord, Windows, Excel, PowerPoint, OS/, Novell and Win. Install, configure, and upgrade PCs, laptops, and printers in a networked environment.
* Coordinated LAN functions including Hardware/software maintenance, upgrades, and file back up.
* Provided assistance in the administration of LAN Server and functioned as secondary technical resource regarding Mainframe and Nortel Meridian PBX telecommunication equipment. Coordinate and perform IT activities for computer and telephone hardware Moves/Adds/Changes.
* Assisted troubleshooting for Hardware/software and equipment problems in both computer and telecommunications.
* Coordinated remote staff dials in efforts and maintained various logs related to downtime and other user issues.
* Developed training materials for a variety of software applications and assisted in field implementations.
Maximus Boston, MA
Transportation Health Benefits Advisor
* Supervised staff of eight individuals assigned to the Transportation Unit.
* Responded to customer service issues related to transportation issues.
* Served as liaison with selected state contracted Transportation Vendors.
* Accurately calculated, processed and data entered personal reimbursement request.
* Demonstrated extensive knowledge of Mass Health program and HMOs and PCC options.
* Investigated all potential thirdparty resources and facilitated the resolution of issues related to member and provider compliance, participation and conduct.
Blue Cross/Blue Shield North Quincy, MA
Customer Service Representative
* Responded to customer inquiries through unit correspondence and telephone contracts.
* Researched and resolved subscribers benefit issues.
* Determined the status of medical and dental claims and dental issues for approximately Customer Service Representatives.
* Devised matrix for corporate Team Incentive Program.
* Acted as liaison between the Metro Boston Unit and T.I.P. Program and established a LiteLink informational program to increase production.
* Assisted account service associates in priority issues.
* Trained Customer Service staff on dental policies and facilitated unit meetings involving dental claims and customer service issues.
Department Of Employment and Training Boston, MA
Customer Service Representative
* Determined eligibility status of individuals applying for unemployment compensation.
* Reviewed applications and researched employment histories.
* Investigated and moderated labor relation discrepancies between employer and employee.
EDUCATION: Bay State Junior College, Boston, MA
Associates Degree in Business Administration,
REFERENCES: Furnished upon request