Henrietta Brown
Jacksonville,FL
Summary
Knowledgeable and dedicated customer service professional with extensive experience in the health care industry. Solid team player with outgoing, positive demeanor and proven skills in establishing rapport with clients. Motivated to maintain customer satisfaction and contribute to company success. Specialize in quality, speed and process optimization. Articulate, energetic and results-oriented with exemplary passion for developing relationships and cultivating partnerships. Strong leader and problem-solver dedicated to streamlining operations to decrease costs and promote organizational efficiency. Uses independent decision-making skills and sound judgment to positively impact company success. Encouraging manager and analytical problem-solver with talents for team building, leading and motivating, as well as excellent customer relations aptitude and relationship-building skills. Proficient in using independent decision-making skills and sound judgment to positively impact company success. Dedicated to applying training, monitoring and morale-building abilities to enhance employee engagement and boost performance.
Overview
26
26
years of professional experience
Work History
Business Process Analyst
Highmark Blue Cross Blue Shield
01.2019 - 01.2023
- Analyzed business operations to identify areas for improvement and develop strategies for enhancement
- Communicated operational requirements to relevant teams and ensured effective collaboration
- Coordinated and monitored project progress to ensure adherence to timelines
- Liaise with customers and colleagues, articulating issues and proposing solutions
- Conducted pre- and post-implementation reviews to optimize processes
- Assisted in planning and facilitating functional walk-throughs
- Received guidance from experienced team members as needed
- Managed cross-functional projects and change initiatives, leading organizational change efforts
- Facilitated process improvement discussions and meetings
- Evaluated business functions to pinpoint inefficiencies and propose solutions
- Created process maps and documented current and future state processes
- Improved reliability by promptly removing problematic web content and notifying all impacted internal/external stakeholders
- Maximized effectiveness by recommending process efficiencies, improvement strategies, and solutions to synchronize technology with business strategies
- Enhanced departmental efficiency through timely review and transition of all documents within specified deadlines
- Optimized portal performance, resulting in timely delivery of membership packets to individuals
- Played an integral role in creating robust desktop procedures and training materials.
Enrollment & Billing Supervisor
Highmark Blue Cross Blue Shield
01.2012 - 01.2019
- Supervised personnel to ensure effective performance
- Monitored and maintained acceptable levels of performance, productivity, and quality
- Provided career development opportunities to enhance employee performance
- Executed administrative tasks including performance reviews, timekeeping, and training requests
- Offered guidance to staff on complex issues and addressed escalated matters promptly
- Reviewed daily inventory and staffing levels to make appropriate assignments
- Scheduled meetings to communicate updates and changes to staff
- Tracked staff performance in service administration, including selection, training, and motivation
- Foster a supportive work environment that encourages continuous improvement
- Managed alternative work schedules and provided ongoing coaching for employee development
- Served as a subject matter expert on billing, membership, and enrollment issues
- Conducted interviews, ensured proper training for new hires, and provided regular performance feedback
- Researched quality issues, responded to error assessments, and analyzed trends for proactive measures
- Maintained compliance with all Pennsylvania Insurance Department regulations, HIPAA, SOX and Highmark Operational and Corporate policies
- Improved operational efficiency by consistently monitoring and recommending process improvements, streamlining workflows, and eliminating manual tasks to boost accuracy and timeliness
- Boosted customer satisfaction by promptly and accurately resolving all inquiries related to membership, billing, or enrolment
- Consistently provided timely technical guidance and updates, ensuring a comprehensive understanding of training materials among all staff
- Enhanced efficiency by delegating work items to staff members proficient in swiftly resolving less complex and duplicate cases
- Optimized overall team efficiency by over 50% within weeks by coaching and effectively guiding employees
- Facilitated timely communication and recommended corrective actions to address declining performance standards by implementing proactive monitoring of employee performance
- Avoided further audits by promptly addressing the DOI complaint, ensuring compliance and resolving issues efficiently.
Customer Service Supervisor
Highmark Blue Cross Blue Shield
01.2010 - 01.2011
- Highmark acquired Blue Cross Blue Shield of Delaware in 2011
- Instrumental in mapping Blue Cross Blue Shield team’s tasks and processes to ensure smooth integration into Highmark culture
- Created implementation plan to guide team’s successful integration and adoption of Highmark’s platform
- Utilized medical terminology, CPT, and ICD-9 coding to process straightforward medical claims adjustments
- Interpreted, analyzed, and resolved inquiries regarding claim status and payments from medical providers
- Submitted adjustment or correction requests for claims through internal systems and liaised with other departments for necessary information
- Employed a behavioral interviewing style to identify candidates with relevant soft skills for hiring purposes
- Contributed to the development of targeted behavior-based questions and conducted interviews to identify candidates best suited for efficiently handling member calls
- Slashed costs by recruiting and training a new class of 15 representatives, completing training within two months, and avoiding attrition
- Surpassed MTM benchmarks for both timeliness and accuracy.
Provider Service Representative
Highmark Blue Cross Blue Shield
01.2008 - 01.2010
- Processed written and telephone requests from providers with accuracy and efficiency, adhering to company guidelines and regulatory requirements
- Facilitated provider education on billing procedures, coding updates, and utilization management policies
- Collaborate cross-functionally with internal departments to streamline processes, resolve complex issues, and improve overall provider satisfaction
- Adjusted simple medical claims adjustments using knowledge of medical terminology, CPT and ICD-9 coding
- Interpreted, analyzed, and resolved inquiries pertaining to claim status and payments
- Submitting requests for adjustments or corrections of claims via internal systems, as well as inquiries to other departments to obtain information necessary to correctly adjudicate claims
- Achieved and surpassed MTM measures for timeliness and accuracy while handling telephone and written inquiries from medical service providers and members.
Administrative Assistant/Database Manager
Professional Counseling Resources Inc.
01.2007 - 01.2008
- Functioned as liaison and point of contact for all users, used Client Relationship Management software to create and maintain a database of customers, partners and program participants for nonprofit agency
- Coordinated communication with outbound team to ensure that all contact events were documented and trackable
- Utilized MS Word, Excel, and SalesForce to produce reports and action plans for staff and management regarding program performance.
Marketing Technician
Zutz Group/Hilb Rogal & Hobbs
01.2006 - 01.2007
- Utilized CRM software (Zywave) to manage database of clients and insurance carrier contacts
- Provided administrative support to producers and account managers in sales and marketing of employee benefits to new and prospective clients via telephone & email communications, maintenance of electronic and paper files
- Coordinated meetings/conferences with carrier representatives regarding new products and services available for marketing to clients
- Provided research and immediate production of reports within tight timeframes (i.e
- Produced updated quotations during client meetings)
- Facilitated written responses and email messages related to requests for proposals
- Maintained knowledge base via self-education pertaining to new products, industry changes, coverage, and technology to provide “best in class” service to agency clientele.
Outbound Managed Care Tele Representative
AstraZeneca Pharmaceuticals
01.2004 - 01.2006
- Contacting approximately 50-60 health care professionals and pharmacists per day to communicate formulary updates, product information and/or specific offers through a live teleconference
- Capturing and communicating key customer information to share with field-based Pharmaceutical Sales Specialists and other company personnel, resulting in the increase of sales revenue
- Collaborating with Information Center Leadership Team and program sponsors in the development of best practices for continuing outbound programs
- Planning and facilitating weekly meetings for the outbound team
- Assisting with the training and orientation of new outbound team members.
Customer Service Representative
AIG Claim Services
01.2003 - 01.2004
- Researching and resolving domestic and international inquiries from insured parties and medical providers (i.e
- Benefit verification, resolving claim adjudication inquiries, processing requests for claim forms, etc.) via telephone, e-mail, and postal mail
- Utilizing available resources to obtain product and claims information (i.e
- Systems, departments, brokers/agents)
- Acting as liaison between policyholders and claims adjusters, gathering and communicating information regarding active worker’s comp and accidental injury claims
- Providing verbal/written resolution to inquiries.
Customer Service Supervisor
Aetna Inc.
01.1998 - 01.2003
- Interviewing and hiring Customer Service Professionals (CSPs)
- Supervising a team of 12-15 CSPs in a call center to ensure prompt and accurate delivery of customer service
- Researching and resolving escalated customer inquiries and interacting directly with customers as necessary
- Collaboratively working with team and peers to meet department goals to foster team approach to meeting key performance measures (Quality, Calls Per Hour, and Schedule Adherence)
- Managing team development through continuous coaching, training and motivation
- Executing quality program, identifying quality trends and recommended process improvements and training needs to improve quality
- Creating and further developing scorecard measures for individual, unit, and department level
- Assisting staff in resolving complex issues and support in handling of difficult calls/cases
- Partnering with management in other departments to resolve recurring issues that increased incoming phone volume (i.e
- Implementation of mass claims processing projects and training of reps to perform simple claims processing resulting in the reduction of phone volume by 10%)
- Providing ongoing progress reports/action plans to staff (via team and 1 on 1 meetings) utilizing MS Office products (MS Word, Excel, PowerPoint)
- Monitoring call demand and staff resources to meet established service levels (using call management software: Telecenter System (TCS); Real-Time Adherence (RTA); Lucent CentreVu Supervisor)
- Managing Human Resource functions (Payroll, Corrective action, Attendance tracking)
- Identifying and developing high performers to assume additional responsibilities and progression in their chosen career path
- Participating in cross-functional teams to gather feedback and implement process improvements.
Customer Service Professional
Aetna Inc.
01.1997 - 01.1998
- Handling approximately 70-85 inbound member calls per day
- Providing high quality “member-centric” service using applicable knowledge of plans and products, through utilization of technology and best business practices
- Utilizing available resources to obtain information (i.e
- Internal systems, contact with external customer/constituent)
- Performing billing reconciliation for individual member accounts and ordering adjustments when required
- Resolving member issues through communication with members, providers, and plan sponsors
- Utilizing available systems to track all events and outcomes
- Processing medical claims (submitted via HCFA 1500 and UB92 forms) using knowledge of medical terminology, CPT and ICD-9 coding
- Providing mentoring and support to peers (as Lead Associate).
Service Quotes Specialist
Agilent Technologies
01.2006
- Generated and forwarded (via e-mail or fax) service quotes to customers needing service on analytical instruments not covered by support agreement or warranty
- Interacted with technical support engineers to obtain pertinent information necessary to quote service requests
- Communicating with credit analysts to obtain approval to quote customers with credit issues
- Escalating quoted service requests for which customers call back requesting additional information (i.e
- Confirmation of receipt of purchase orders, instructions on how to complete paperwork sent to the customer along with the quote, or detailed explanation of the quote)
- Using appropriate systems (Siebel, SAP R/3, MS Office Suite) to obtain product information needed to produce quote
- Monitoring and updating service requests that have been outstanding (no method of payment received) in excess of thirty days.
Education
Health Claims Certification -
Harris School of Business
01.2009
Associate Arts Degree -
Florida State College-Jacksonville, FL
01.1995
State of Delaware Accident & Health Insurance License -
01.2007
Diploma -
Robert E. Lee Senior High School
01.1992
Skills
- Customer Relations
- Team Training & Development
- Active Listening & Critical Thinking
- Administrative Services & Support
- Project Coordination & Support
- Business Process Improvement
- Internal Client Engagement
- Problem Solving & Decision Maker
- Process Analysis & Optimization
- Resource Allocation
- Documentation Management
- Quality Assurance
Accomplishments
- Recipient of “Spirit of Excellence” Award – 1997 and 1998
- Recipient of “Excellence In Service” Award – 2000
Timeline
Business Process Analyst
Highmark Blue Cross Blue Shield
01.2019 - 01.2023
Enrollment & Billing Supervisor
Highmark Blue Cross Blue Shield
01.2012 - 01.2019
Customer Service Supervisor
Highmark Blue Cross Blue Shield
01.2010 - 01.2011
Provider Service Representative
Highmark Blue Cross Blue Shield
01.2008 - 01.2010
Administrative Assistant/Database Manager
Professional Counseling Resources Inc.
01.2007 - 01.2008
Marketing Technician
Zutz Group/Hilb Rogal & Hobbs
01.2006 - 01.2007
Service Quotes Specialist
Agilent Technologies
01.2006
Outbound Managed Care Tele Representative
AstraZeneca Pharmaceuticals
01.2004 - 01.2006
Customer Service Representative
AIG Claim Services
01.2003 - 01.2004
Customer Service Supervisor
Aetna Inc.
01.1998 - 01.2003
Customer Service Professional
Aetna Inc.
01.1997 - 01.1998
Health Claims Certification -
Harris School of Business
Associate Arts Degree -
Florida State College-Jacksonville, FL
State of Delaware Accident & Health Insurance License -
Diploma -
Robert E. Lee Senior High School
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