Danielle Moss
West Monroe,LA
Summary
Experienced supervisor with a strong record of enhancing compliance, streamlining processes, and driving improvements in output, quality, and customer satisfaction. Possesses extensive knowledge of process optimization and data analysis, leveraging this expertise to drive operational efficiency. Recognized for outstanding performance as supervisor of the month on multiple occasions.
Overview
14
14
years of professional experience
Work History
Lead Claims Specialist
Kelly Services/Maximus
01.2022 - Current
- Processes claims accurately through detailed investigation, ensuring compliance with regulations.
- Analyzes insurance claims to prevent fraud.
- Prepares reports by collecting, analyzing, and summarizing information.
- Resolves claims by approving or denying documentation, calculating benefits due, and determining compensation settlement.
- Ensures legal compliance by following company policies, procedures, and guidelines, as well as state and federal insurance regulations.
- Maintains quality customer service by following customer services practices and responding to customer inquiries.
- Provides legal support by assembling documentation for settlement action.
- Protects operations by keeping claims information confidential.
- Strengthens connections with departmental teams of insurance firms.
Supervisor
Maximus
02.2018 - 01.2022
- Workforce Planning and Employment
- Implementing the organization's recruiting strategy
- Conducted applicant interviews.
- Supervised team within department to maintain efficient contact center operations.
- Delivered consistent coaching to enhance productivity, quality, attendance, and performance.
- Ensure consistent follow up and communication
- Supported in conducting background screenings.
- Processing transfers, promotions, and terminations
- HR Development
- Provide information to the external accountant who creates the company's financial statements
- Ensure all agents are compliant with HIPPA and Medicare Fraud, Waste and Abuse rules and regulations at all times
- Respond and communicate promptly to all inquiries received via email, text and phone
- Prepare monthly, quarterly and annual reports
- Utilize data to support assumption and outcome evaluations
- Monitor daily attendance, break and approved Paid Time Off (PTO) requests
- Review and ensure payroll time sheets are accurate for each team member
- Attend and conduct meetings as required of the position
- Led employee training initiatives to enhance skill sets and performance.
- Directed completion of special projects.
Customer Service Representative/Team Lead
Centurylink/lumen-Remote
01.2015 - 02.2018
- Provide professional, courteous and accurate information to all callers
- Support Inbound/Outbound phone calls as well as Chats from Members or Providers on routine or simple issues
- Ability to effectively communicate in a professionally setting
- Capable of meeting/ exceeding individual performance goals established for the position in the areas of: Call Quality, Attendance, Adherence and other Contact Center objectives
- Able to proactively engage and collaborate with varies Internal/ External departments
- The ability to work independently and as a reliable team member
- Ability to work regularly scheduled shifts within our hours of operation, where lunches and breaks are scheduled and work over-time and/or weekends, as needed
- Trained other agents on the new systems so agents can be ready for live environment
- Respond to inbound chats in a timely manner
- Establish and maintain quality relationships with consumers by delivering exceptional service, establishing rapport, and identifying and meeting needs and expectations
- Use sales skills to build customer base and have the autonomy to make decisions as they relate to daily priorities and assigned tasks
- Identify and help solve customer issues quickly and effectively
Team Lead
Omni Interactions, Inc.
04.2011 - 10.2015
- Make and complete member retention and recruitment calls while hitting closely tracked volume and success metrics
- Clearly document all member-related communication and activity in Salesforce
- Maintain documentation such as call scripts, troubleshooting articles, email templates and FAQ's, updating as needed
- Respond to escalated inquiries and complaints according to protocol and SOP's
- Identify and execute additional projects and processes to improve the member experience and internal operational efficiencies
- Develop and manage customer relationships to retain existing revenue inclusive of primary contract renewal responsibility within assigned 'Gold' account base
- Work delegated cases from Sr Customer Engagement Advocate and Customer Engagement Advocate II, via cases in Salesforce
Education
Bachelor's - Business administration
Walden University
Associate - Business Administration
McCann School of Business & Technology
Monroe, LA12.2017
Skills
- Inventory
- Microsoft Excel
- Microsoft Office
- Organizational Skills
- Scheduling
- Quickbooks
- Excel
- Management
- Problem Solving
- Sales
- Outlook
- Forecasting
- Databases
- Supervising Experience
- Data Entry
- Meeting Planning
- Multi-line Phone Systems
- Typing
- Microsoft Word
- Salesforce
- Avaya
- Payroll
- Office Management
- Project Management
- Leadership
- Bookkeeping
- Human Resources
- Recruiting
- Windows
- Quality Assurance
- Project Planning
- Microsoft Project
- Project Implementation
- Customer Relationship Management
- SAP
- Relationship Management
- Customer Support
- Operations Management
- Live Chat
- Documentation Review
- Team Management
- Microsoft SharePoint
- Google Suite
- Pegasystems
- Genesys
- Communication Skills
- HIPAA
- Order Entry
- Clerical Experience
- Personal Assistant Experience
- Creative Problem Solver
- Quick Learner
- Training Development Aptitude
- Exceptional Communication Skills
Personal Information
- Willing To Relocate: Anywhere
- Authorized To Work: US for any employer
Languages
English
Elementary
Timeline
Lead Claims Specialist
Kelly Services/Maximus
01.2022 - Current
Supervisor
Maximus
02.2018 - 01.2022
Customer Service Representative/Team Lead
Centurylink/lumen-Remote
01.2015 - 02.2018
Team Lead
Omni Interactions, Inc.
04.2011 - 10.2015
Bachelor's - Business administration
Walden University
Associate - Business Administration
McCann School of Business & Technology
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