Ashlee Stafford

• Ensure accurate and timely processing of fraud and claims transactions
• Develop and implement fraud and claims policies and procedures
• Investigate and resolve customer complaints related to fraud and claims processing
• Maintain accurate and up-to-date records of fraud and claims activities
• Identify and report any suspicious activity or potential fraud
• Develop and maintain relationships with external partners and stakeholders
• Provide training and support to staff on fraud and claims processes and procedures
• Coordinate with other departments to ensure appropriate processes are followed
• Monitor and analyze fraud and claims trends to identify potential risks and areas for improvement
• Review and update existing fraud and claims processes and procedures on an ongoing basis
• Support senior management in developing and executing strategies to reduce fraud and claims losses

• Investigate and respond to written regulatory complaints that customers file against Green Dot to attain the best possible response and resolution

• Responsible for facilitating and resolving the most escalated customer-initiated issues to the highest professional standards via phone, email or letter correspondence.

• Provide accurate and comprehensive written analysis and responses to customer complaints that have been filed with a state or federal regulator within the appropriate timeframes

• Ensure that all customer escalations that have been filed with a state or federal regulator are managed to excellent professional standards and within Green Dot terms and policies

• Facilitate customer contact via phone, email or letter correspondence to research and resolve the customer's issues

• Demonstrate ownership of customer issues and work proactively with Green Dot business units, partners, and vendors to manage issues through to a complete resolution in a timely manner

• Demonstrate sound negotiation, problem-solving and conflict resolution skills by working to resolve issues within your own authority and parameters, whenever possible, while utilizing sound judgment to understand when it will be both effective and necessary to escalate to a higher authority

• Demonstrate ability to understand the big picture and identify the underlying drivers causing complaints by capturing, reporting, and analyzing systematic issues and recommending solutions to improve processes and products

• Utilize appropriate tools to ensure the customer receives relevant information and identify knowledge gaps and/or outdated policy/procedure which caused front-line efforts to fail

• Support Green Dot employees and executives with resolving customerissues

• Maintain contact with all other relevant customer groups within Green Dot to ensure support for resolution of customer issues, consistency of approach and smooth cross-department cooperation

• Actively participate in ensuring that Green Dot knowledge base is up to date

• Manage a team related to compliance and regulatory issues discovered during the investigation

• Ensure positive client experiences through high quality service and communication
  
• Respond to shared inbox inquiries from clients and internal partners within expected time frames, providing regular updates to the client through resolution
  
• Review and work all open cases for clients
  
• Run and work full and quick audit reports to ensure all member records are accurate and transactions have been processed correctly, resulting in accurate coverage
  
• Manage client deliverables, track progress and complete assigned work through company planning tools
  
• Maintain accountability for inbound and outbound files.
  
• Maintain carrier and client SFTP setup and completion of updates as needed
• Daily review of incoming data files, and carrier discrepancy reporting
  
• Execution of client specific process and procedure
  
• Complete risk mitigation reporting to include audits, team activity and case manager reports
  
• Communicate daily to alert team of issues or red flags with client data or files, reviewing warnings, errors and file failures during daily stand-up and identifying team members responsible for resolution
  
• Working with Carriers on ongoing file updates and requests
  
• Function as the primary point of communication for our Carrier partners
  
• Communicate updates to Client Services and technical partners as required
  
• Identify root cause of any systemic issues

• Quickly build rapport and respond to plan participants in a compassionate manner by identifying and exceeding expectations by responding in a respectful, accurate, timely manner, consistently meeting commitments via phone, email and instant message
  •Ability to customize customer service approach to meet all types of communication styles and personalities while maintaining professionalism and diplomacy during difficult calls
  •Handle confidential information with sensitivity and discretion in accordance with HIPAA and Data Privacy laws and company data security requirements
  •Skillfully translate health and welfare and pension terms, complex plan information and processes into simple explanations and instructions that customers can understand and act upon.
  • Read and understand client’s plan documents and online knowledgebase tools while collecting relevant information to determine immediate requests/questions and also to anticipate the future needs of the member
  • Demonstrate knowledge, understanding and compliance with company and client procedures and guidelines providing appropriate and accurate information
  • Maintain and document complete and accurate call and case notes in a professional manner
  • Regularly participate in team meetings and training
  • Perform other duties as assigned

• Responsible for responding to inquiries and complaints on more complex products/services and/or from premier customers.

• Resolving complex inquiries and complaints from internal and external customers and upon escalation

• Processing complex transactions on-line

• Performing extensive research to resolve the complex customerproblems

• Providing guidance and assistance to less experienced representatives either on the spot and/or viatelephone

• Providing training on policies and procedures, new or enhanced services and/or procedural changes

• May also offer or recommend products and services based on customer needs

• Review data and report trends to management, and project work

• Managed senior-level personnel working in marketing and sales capacities.
• Increased employee retention rates through development and implementation of effective career progression paths for staff members.
• Established performance goals for employees and provided feedback on methods for reaching those milestones.