AMY CALDERON
Aldie,VA
Summary
Assists with identifying and communicating any change in Exchange eligibility and enrollment Management professional effective at building highly-motivated teams, as well as leading cross-functional teams in a fast-paced environment.
Overview
10
10
years of professional experience
Work History
Lead Business Development Specialist
Health Benefits Exchange Authority
09.2019 - Current
- Am the lead for all Congressional issues/concerns (handle all escalated issues, bill files, questions, etc)
- Conduct regular meetings with Congressional employers to build positive and productive relationships.
- Meet monthly with Congressional employees (help sessions) to provide assistance with enrollment, tech issues, carrier issues, etc
- Conduct QA for all case managers on a weekly or bi-weekly basis (depends on need of the case manager)
- Continue to complete case work on daily basis Am the lead for all contact center issues/concerns (coming from SHOP, MA and/or IVL teams)
- Facilitate the bi-weekly calibration sessions for HBX and contact center (ECC)
- Facilitate the monthly check ins for HBX (Billing, SHOP, IVL and MA) and ECC
- Back up to Alison, who manages the contact center, when she is out of office
- Developed and implemented training programs for staff
- Established and maintained relationships with key stakeholders
Small Business Case Manager
DC Health Benefits Exchange Authority
08.2016 - 09.2019
- Completes all training for SHOP new hires to the Health Benefits Exchange authority; this includes policy training, systems training, processes for the SHOP team and case work
- Manages the Contact Center training of customer service representatives to ensure that they are kept up to date with all policies, procedures
- Initiates and establishes contact with collateral resources within the DC Health Benefits Exchange, such as the eligibility and enrollment team, agency legal staff, community-based brokers and insurance carriers to identify and help resolve enrollment barriers
- Attends Congressional sessions during open enrollment to assist congressional members and staff with enrollment concerns, questions and issues
- Attends community meetings, workshops and special programs to disseminate information to District employers and employees
- Interfaces with community-based brokers, federally qualified health centers, navigators and key stakeholder groups regarding case management services for employers and employees
- Attends meetings and seminars on issues related to health insurance and health care reform that may impact eligibility, enrollment, tax credit eligibility, denial of coverage and appeals in the Health Benefit Exchange.
- Responds to crisis situations and attempts to resolve enrollment problems for employers and employees.
- Participates in conferences, educational training and workshops, and remains fully informed in matters of the ACA and its implementation.
- Maintains statistical data and updates case records which reflect current and accurate data of employers
Contact Center Supervisor
DC HealthLink
09.2014 - 08.2016
- Referred unresolved customer grievances to designated departments for further investigation
- Assesses eligibility for enrollment assistance with DC Health Link insurance products for employers and employees who have applied for insurance through the on-line insurance marketplace
- Evaluated data to identify trends and determine customer service needs
- Interfaces with community-based brokers, federally
qualified health centers, navigators and key stakeholder groups regarding case management services for employers and employees - Policies, federal or local regulations to employers and
employees seeking to enroll in various health insurance products - Responds to crisis situations and attempts to resolve
enrollment problems for employers and employees - Participates in conferences, educational training and
workshops, and remains fully informed in matters of the ACA and its implementation - Investigated and resolved customer inquiries and complaints in an empathetic manner
- Adhered to all confidentiality requirements at all times
- Solved unresolved customer issues. Met all customer call guidelines including service levels, handle times and productivity
- Assumed ownership over team productivity and managed workflow to meet or exceed quality service goals.
- Strong leader of customer support staff. Facilitated inter-departmental communication to effectively provide customer support
- Scheduled staff shifts to cover peaks and lulls in customer inquiries
- Trained staff on operating procedures and company services
- Provided accurate, specific and timely performance feedback for CSR's
- Identified individual development needs with appropriate training
- Compiled and wrote performance evaluations for customer support staff
- Conducted meetings with team members and other management; gave feedback on customer support staff's performance
- Followed through on all critical inter-departmental escalations to increase customer retention rates
- Maintained up-to-date knowledge of product and service changes.
Executive Escalation Specialist
AOL, Inc.
01.2013 - 02.2014
- Promoted superior experience by addressing customer concerns, demonstrating empathy, and resolving problems swiftly
- Educated customers about billing, payment processing and support policies and procedures
- Handled customer complaints that are received from various Executives throughout the company
- Provided excellent customer care by responding to requests, assisting with product selection and handling ordering functions
- Resolved high profile customer issues
- Analyzed issues and trends to make proactive improvements in AOL's business
- Assisted other departments with outreach programs to gather market research
- Interacted with our executive offices regarding the resolution of escalations they receive
- Worked with an extremely tenured team that has passion for resolving members issues and Performed companion calls to develop and train customer support staff
- Provided them best in class customer support
- Managed and handled the day-to-day operations of a third party team consisting of 13 employees based in Panama
Education
Bachelor of Science - Human Resources Management
Southern New Hampshire
Associate of Science - Business Administration
Northern Virginia Community College
Annandale06.2008
Skills
- Product knowledge
- Business-to-customer expertise
- Proficient in Microsoft products
- Staff Management
- Verbal and written communication
- Leadership
- Computer proficiency
- Customer Service and Assistance
- Critical Thinking
- Staff Support
- Staff Training
- Interpersonal Communication Skills
- Account Management
- Continuous Professional Improvement
Languages
Spanish
Native or Bilingual
Timeline
Lead Business Development Specialist
Health Benefits Exchange Authority
09.2019 - Current
Small Business Case Manager
DC Health Benefits Exchange Authority
08.2016 - 09.2019
Contact Center Supervisor
DC HealthLink
09.2014 - 08.2016
Executive Escalation Specialist
AOL, Inc.
01.2013 - 02.2014
Bachelor of Science - Human Resources Management
Southern New Hampshire
Associate of Science - Business Administration
Northern Virginia Community College
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