ANGELA CONYERS
Columbia,SC
Summary
Director Claims and Customer Service with24 years of extensive expertise in management, training, and customer service. Demonstrates strong leadership in guiding multiple operational areas, implementing process improvements, and leading system enhancements.
Overview
23
23
years of professional experience
1
1
Certification
Work History
Senior Director Operations (FEP)
Blue Cross Blue Shield
12.2002 - Current
- Ensure operations fully comply with contractual obligations
- Develop, implement, and assess business operations against benchmarks that measure success in areas like quality, timeliness, customer satisfactions and financial performance
- Analyze performance trends and implement new or improved processes to enhance overall operational outcomes
- Manage budget to ensure cost-effective operations
- Provide direction and guidance to multiple operational areas including Training, Customer and Provider Service, Claims Processing, Other Party Liability, Medicare, Refunds, Medical Management, Business Test Analyst
- Reconsiderations, Quality Control and Audit
- Contributes to consistent annual Enrollment gain and high retention rates by supporting Marketing Representatives and attending Federal Agency Functions
- Review, analyze and respond to audits from Corporate Audit, Office of Personnel Management, Director’s Office, NAIC Model Audit Rule (MAR), and Independent Public Accountant (IPA)
Director Claims Customer Service (FEP)
Blue Cross Blue Shield
01.2017 - 01.2024
- Provide direction and guidance to multiple operational areas including Customer and Provider Service, Claims Processing, Other Party Liability, Medicare, Refunds, Medical Management, Business Test Analyst
- Reconsiderations, Quality Control and Audit
- Track performance and implements process improvements
- Identify system limitations and serves as project leader on system enhancements
- Work with recruiters to execute staffing plans by posting job opening, reviewing resumes, interview and making candidate selections
- Contributes to consistent annual Enrollment gain and high retention rates by supporting Marketing Representatives and attending Federal Agency Functions
- Analyze and execute budget for the department by providing leadership, examining past budgets, estimating future financial needs, and consolidating individual department budgets
- Review, analyze and respond to audits from Corporate Audit, Office of Personnel Management, Director’s Office, NAIC Model Audit Rule (MAR), and Independent Public Accountant (IPA)
- Proactively make recommendations for process improvements and efficiencies for the department to ensure we exceed accuracy and accessibility performance measures
- Make presentations to members and potential members
- Attend and conduct meetings regarding the department
Manager, MSR and Claims (FEP)
Blue Cross Blue Shield
01.2007 - 01.2017
- Manage claims and customer service units to ensure prompt equitable and accurate settlement of all claims and customer service items by operating efficiently through appropriate planning, problem solving, and staff motivation
- Analyze problems/concerns and make effective decisions that provide positive solutions
- Analyze and execute budget for the department by providing leadership, examining past budgets, estimating future financial needs, and consolidating individual department budgets
- Conduct focus audits to ensure quality standards
- Proactively make recommendations for process improvements and efficiencies for the department
- Assist with audits received from the Office of Personnel Management and the Blue Cross Blue Shield Association
- Liaison between Corporate Audit and FEP
- My staff and I also conduct HIPAA Privacy training for the department
- Make presentations to members and potential members
- Attend meetings regarding the department
- Supervise Coordination of benefits unit, Correspondence and Reconsiderations and Appeals
- Plan System Administrator for FEP’s national system
- The Plan Administrator is responsible for creating and updating user account information
- Monitor and ensure Plan Managers have completed the role and permission validation for users and monitor and review the certification/recertification activity of assigned users
Manager
Pizza Hut
01.2012 - 01.2014
- Completed payroll processing for all employees, ensuring timely and accurate payments
- Lead and motivated a team of employees to ensure customer satisfaction, quality standards, and operational excellence
- Ensure compliance with all company policies and procedures, including safety and security protocols
- Managed inventory levels, ordering supplies as needed and tracking usage to maintain cost control
- Trained new staff members on proper food handling techniques, customer service skills, and other job duties
Manager
1-800-Medicare
01.2005 - 01.2007
- Establish and maintain a high level of customer service with all internal and external customers
- Direct and supervise associates to ensure that all inquiries are handled in an effective and efficient manner to meet and exceed contract standards
- Prepare and analyze reports on quality, timeliness, and service; provide coaching to customer service representatives based on results of quality control monitoring audits and provide education and training regarding policies and procedures
Customer Service Specialist
01.2004 - 01.2005
- Review and analyze CMS documentation including transmittals, program agenda, and laws governing Medicare
- Direct coordination with the other Medicare departments to ensure compliance with CMS mandates
- Administer all department training activities and provides training to other Medicare departments on service center topics
- Write, update, and maintain desk procedures
- Prepare CSR quality and productivity reports
- Prepare daily, weekly, monthly, and annual call reports
Claims Associate IV (Tricare For Life)
01.2003 - 01.2004
- Researches and responds to priority or highly complex written and telephone inquiries and complaints
- Responsible for supervisor call backs, error correction reports, and daily performance reports
Claims Associate III (Tricare For Life)
01.2002 - 01.2003
- Researches and responds to telephone and correspondence inquiries according to desk procedures, ensuring that contract standards and objective for telephone timeliness, correspondence cycle time, quality and productivity are met
Education
M.B.A. - Business Administration
University of Phoenix
Columbia, SC01.2007
B.A. - Business Administration and Management
Morris College
Sumter, SC01.1999
High School - General Studies
Manning High School
Manning, SC01.1995
Skills
- Tricare For Life Testing, HIPPA Claims Medical Management System, Ulysses Certified, Delta Sigma Theta Sorority, Inc, Member Phi Beta Lambda Business Fraternity
Certification
Management Coaching, Manager Acceleration Program, DDI Management Training Program, Facilitation Skills Training, Coaching Skills Training, Procurement Training, Corporate Planning and Strategic Services Training, Diversity, and Inclusion Training
Timeline
Director Claims Customer Service (FEP)
Blue Cross Blue Shield
01.2017 - 01.2024
Manager
Pizza Hut
01.2012 - 01.2014
Manager, MSR and Claims (FEP)
Blue Cross Blue Shield
01.2007 - 01.2017
Manager
1-800-Medicare
01.2005 - 01.2007
Customer Service Specialist
01.2004 - 01.2005
Claims Associate IV (Tricare For Life)
01.2003 - 01.2004
Senior Director Operations (FEP)
Blue Cross Blue Shield
12.2002 - Current
Claims Associate III (Tricare For Life)
01.2002 - 01.2003
B.A. - Business Administration and Management
Morris College
High School - General Studies
Manning High School
M.B.A. - Business Administration
University of Phoenix