Erica Martin
Polk City,IA
Summary
Dynamic and dependable Provider Network Coordinator with over 20 years of experience delivering exceptional verbal and written support. Expertise in swiftly resolving inquiries and grievances enhances customer satisfaction while fostering strong relationships with cross-functional teams to achieve optimal outcomes. A proven track record of implementing effective solutions and maintaining high-quality care reflects a commitment to operational efficiency and continuous improvement. Strong analytical, communication, and teamwork skills, combined with adaptability to new tasks and challenges, are complemented by a positive attitude and dedication to ongoing professional development.
Overview
20
20
years of professional experience
Work History
Network Operations Coordinator
Wellmark, Blue Cross Blue Shield
Des Moines, IA
07.2017 - Current
- Fostered and maintained strong business relationships with providers to enhance collaboration with network stakeholders.
- Cultivated and sustained positive business relationships with Wellmark stakeholders to enhance operational efficiency.
- Oversaw timely resolution of provider inquiries related to Wellmark's systems and processes. Coordinated document triage to effectively assign and monitor provider inquiries. Leveraged the engagement management system to streamline the tracking and resolution of provider inquiries.
- Conducted comprehensive analysis of provider inquiries, collaborating with subject matter experts to identify effective resolutions.
- Guided providers through the inquiry and resolution process by delivering real-time education on web resources and tools, promoting self-service capabilities.
- Identified and addressed provider training needs, enhancing the inquiry and resolution process. Delivered insights on training opportunities derived from escalated inquiries, fostering provider development. Collaborated with stakeholders to implement targeted training solutions based on identified trends.
- Facilitated seamless operational support, enhancing collaboration between internal stakeholders and providers on business processes. Crafted comprehensive process checklists, workflow maps, and Q&A documents, resulting in improved efficiency. Developed strategic summary documents and timely talking points by collaborating closely with leadership and subject matter experts across Wellmark divisions.
- Facilitated and delivered structured education and training sessions to internal business partners and external providers as directed by leadership.
- Developed and maintained documentation for network operations procedures and guidelines.
- Led training sessions for new team members on network protocols and operational standards.
Senior Inquires Specialist
Wellmark, Blue Cross Blue Shield
Des Moines, IA
05.2011 - 06.2017
- Executed detailed analysis and resolution processes for appeals and inquiries to ensure compliance and customer satisfaction.
- Monitored, tracked, and documented all inquiries and their resolutions.
- Championed customer advocacy by coordinating research and resolving inquiries.
- Facilitated negotiations to effectively resolve issues and conflicts while demonstrating composure and confidence.
- Addressed and remediated claims to ensure compliance with processing time standards and accurate modifications.
- Facilitated communication and resolution confirmation with members, providers, legislators, and external review entities, ensuring clarity and understanding.
- Defined, implemented, and refined process workflows to optimize operational efficiency.
- Engaged with various departments to identify and resolve challenges while enhancing operational workflows.
- Monitored industry developments to pinpoint and communicate emerging trends.
Customer Service Associate III
Wellmark, Blue Cross Blue Shield
Des Moines, IA
05.2006 - 05.2011
- Cultivated and strengthened member relationships to enhance overall satisfaction.
- Technical knowledge of customer service systems and processes.
- Resolve difficult member and provider situations.
- Facilitated educational sessions for members and providers regarding Wellmark products and services.
- Trained new employees and provided subject matter expertise to peers.
- Researched complex member, agent, and provider inquires.
Education
Bachelor of Science - Business Administration
AIB College of Business
Des Moines, IA05-2011
Skills
- Microsoft Office proficiency
- Issue resolution
- Effective listening
- Analytical reasoning
- Customer service
- Computer proficiency
- Complaint handling
- Microsoft Excel
Accomplishments
- 38% above Special Inquiries team average in productivity
- 1 of 2 specialist chosen to work Facets accounts in Special Inquires
- Co-chaired Wellmark’s WOW employee awards program.
- Participated in committee greenbelt projects (“Soft skills” and “Calls you don’t take”).
- Facilitated transition pod.
Timeline
Network Operations Coordinator
Wellmark, Blue Cross Blue Shield
07.2017 - Current
Senior Inquires Specialist
Wellmark, Blue Cross Blue Shield
05.2011 - 06.2017
Customer Service Associate III
Wellmark, Blue Cross Blue Shield
05.2006 - 05.2011
Bachelor of Science - Business Administration
AIB College of Business
Skill Highlights
- Comprehensive knowledge of Appeals, Insurance Division Inquires, Claims Adjustments, Customer Service and Wellmark/ health insurance products
- Excellent communication and interpersonal skills verbal or written
- Talent to educate others about specific details of Wellmark’s products
- Extremely organized and detail-oriented
- Ability to analyze and resolve problems using resources given with good judgement
- An avid team player with the proven ability to lead and coach others
- More than 16 years of experience in claims, benefits, and customer service in the insurance industry
- Power to prioritize and multi-task to ensure maximum efficiency and accuracy