SUPERVISOR CORRESPONDENCE/EMAIL/TELEPHONE/CDH AUDIT CUSTOMER
CareFirst BCBS
Owings Mills, MD
03.2004 - 07.2021
- Manager - Marvalyn Threat 443-738-7126.
- Managed customer service team that acted as a resource to members and providers in the education, communication and processing of group benefit coverage, claims resolution and eligibility corrections.
- Managed, supervised, and coached departmental phone and non-phone inventory teams to meet departmental and company goals which was to work and finalized claim reconciliation issues and provide benefit answers to providers and members.
- Supervised and coached team on primary, secondary, and tertiary claim issues including Medicare Supplemental claims and policies by reviewing CPT, Revenue, HCPCS, ICD9 along with Carefirst standard operating procedures and regulatory guidelines.
- Managed, supervised, and coached the CDH Audit team which audited medical claim totals in Facets and pharmacy claim totals on the CVS pharmacy system for CDH policies that include medical and pharmacy under one deductible and or out-of-pocket expense. Updated systems to the correct deductible and or out of pocket totals.
- Supervised three teams, the Correspondence and Email teams for medical and dental appeal cases, and the CDH Audit team simultaneously.
- Yearly, all three teams exceeded timeliness goals which also handled Executive Inquiry, Privacy Office, and Maryland Insurance Commission cases.
- Supervised the Adjustment Team and the Clerical Team for 3 years.
- Responsibilities included managing and monitoring cases sent for upward and downward adjustments to meet departmental accuracy and timeliness goals.
- Also managed and monitored clerical inter-office mail routing and mail distribution.
- As a Supervisor, I helped team members increase quality and production scores by helping the associate understand their goals, job responsibilities, understand customer needs and the resources needed to help them and complete the case.
- Management routinely assigned low achieving associates to my team for me to help them improve by understanding their goals, job responsibilities, understanding customer needs and the resources needed to complete case.
- Compiled data for Daily Inventory Report for upper management for total cases, the percentages of email cases over 10 days, and percentage for email, correspondence, and phone cases over 21 days for Provider and Member Customer Service.
- Compiled case inventory data for the Small Group SBU Daily Inventory Report on excel reports and distributed the report via email every morning to upper management with the roll up of the department's total phone, correspondence and email aged case percentages for Member and Provider Services combined.
- Monitored and distributed to associates, FACETS phone, correspondence, and email cases on excel reports for medical and dental cases to be worked daily to ensure case timeliness goals were met.
- Responsible for interviewing and promoting associates to work on the Correspondence, Email and CDH Audit teams.
- Trained newly promoted associates on Correspondence, Email, CDH Audit and claim adjustments to increase skill base for case resolution.
- Responsible for grooming and choosing phone associates to work on the case inventory team to meet departmental and company goals.
- Monitored and coached associate’s quality audit cases and scores to ensure departmental quality goals were met.
- Monitored departments aged cases and worked with management from other departments on a priority basis to ensure cases we routed to other areas were completed and routed back for closure within company guidelines.
- Worked with the Regulatory Department, Project Management Team and Training on a continuous basis to improve quality and make updates to the Standard Operating Procedures to better improve services for the employees and customers
- Responsible for on-site and off-site training and creation or updating Standard Operating Procedures for customer service Correspondence and Email workflows, case management and case-loading in FACETS, Blue Cross Blue Shield primary and Medicare Supplemental policies.
- Utilized FACETS to monitor and coach team members for first pass claim resolution, to generate reports.
- Directed inventory management, case status and case completion rates.
- Supervised ongoing daily production phases.
- Located and resolved problems with team production and performance to maintain consistent quality levels.
- Collaborated with other leaders and executives to direct workflow and support operations.
- Kept accurate and detailed records of personnel progress and productivity.
- Monitored daily and weekly key performance indicators to maintain on-track status.
- Implemented policies and standard operating procedures for continuous improvement.