Summary
Overview
Work History
Education
Skills
Quote
Generic

LISA ADAMS

Sacramento,CA

Summary

Extensive experience in the Healthcare industry with reputable skill in relationship building, resourcefulness, priority management and optimization of organizational effectiveness. Highly motivated and results driven with commitment to continuous innovation. Dedicated Customer Service professional with knowledge of service delivery and proven multitasking abilities. Committed to maintaining professional relationships to increase profitability and drive business results. Skilled Service Representative driven to maximize customer satisfaction. Eager to leverage 34 years of experience in dynamic new position with long-term career potential and room for advancement. Knowledgeable and dedicated customer service professional with extensive experience in 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, cultivating partnerships and growing businesses. 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. Hardworking and passionate job seeker with strong organizational skills eager to secure entry-level [Job Title] position. Ready to help team achieve company goals. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy. To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.

Overview

34
34
years of professional experience

Work History

Employer Service Representative

Elevance
01.2023 - Current
  • Provided operational support and expertise, as well as single point of service support for client requests, member billing, and associate training
  • Service complex client accounts with timely and effective responses to the clients regarding claims and service-related concerns
  • Sustain operational team awareness of claims root cause issues, service-related trends, and points of member abrasion
  • Host external audits for multiple clients and reported findings accordingly
  • Lead weekly/monthly meetings regarding claim and phone process improvements for the operations department
  • Distribution of communications and documents to operational team on workflows issue and guidelines to assist in processing accuracy
  • Provide coaching to associates, when necessary, office-wide
  • Responded to customer concerns with friendly and knowledgeable service and remedied issues promptly and effectively.
  • Maintained productivity and quality standards at all times.
  • Participated in team meetings and training sessions to stay informed about product updates and changes.
  • Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
  • Developed customer service policies and procedures to meet and exceed industry service standards.
  • Analyzed customer service trends to discover areas of opportunity and provide feedback to management.
  • Utilized customer service software to manage interactions and track customer satisfaction.

Process Expert, Sr

06.2018 - 11.2022
  • Scope, operation leader with proven strengths in project management, business implementation and process improvement
  • Significant accomplishments, contributing to overall operational excellence include:
  • End-to-end quality Initiatives – Identifying trending and root cause of operational errors, mentoring fellow leadership in the development and documentation of process improvement, and following up on results to ensure operational excellence
  • Facilitation and oversight of DMHC and external auditing processes
  • All-inclusive administrative support for Director, Union and Legal, to include collection and logging of documentation, coordination of meetings and review of findings
  • Implementation of new programs for the company
  • Some programs, CIW, Solution Central, and Privacy Enhancements
  • Successfully identify system issues, administrative changes, and assisting in the implementation of system fixes
  • Inventory management and creation of action plans for goal pathing
  • Medallia management to review goals and implementing coaching to support associates.

Employer Service Representative, Sr

Anthem
06.2007 - 06.2018
  • Provided operational support and expertise, as well as single point of service support for client requests, member billing, and associate training
  • Service complex client accounts with timely and effective responses to the clients regarding claims and service-related concerns
  • Sustain operational team awareness of claims root cause issues, service-related trends, and points of member abrasion
  • Host external audits for multiple clients and reported findings accordingly
  • Lead weekly/monthly meetings regarding claim and phone process improvements for the operations department
  • Distribution of communications and documents to operational team on workflows issue and guidelines to assist in processing accuracy
  • Provide coaching to associates, when necessary, office-wide
  • Review inline audits when associates do not agree with the error
  • Coached and provide chairside education.
  • Skilled at working independently and collaboratively in a team environment.
  • Self-motivated, with a strong sense of personal responsibility.
  • Proven ability to learn quickly and adapt to new situations.
  • Worked well in a team setting, providing support and guidance.
  • Worked effectively in fast-paced environments.
  • Managed time efficiently in order to complete all tasks within deadlines.
  • Demonstrated respect, friendliness and willingness to help wherever needed.
  • Excellent communication skills, both verbal and written.
  • Participated in team projects, demonstrating an ability to work collaboratively and effectively.
  • Paid attention to detail while completing assignments.
  • Organized and detail-oriented with a strong work ethic.

Quality Auditor II

Anthem
12.2005 - 06.2007
  • Maintained productivity and quality standards at all times.
  • Participated in team meetings and training sessions to stay informed about product updates and changes.
  • Developed customer service policies and procedures to meet and exceed industry service standards.
  • Served as role model for mentees by demonstrating strong values and ethical standards.
  • Facilitated workshops and seminars to foster development of problem-solving, decision-making, and critical thinking.
  • Developed and led special events that increased decision making, problem-solving and good judgment.

Operations Expert

Anthem
10.2004 - 12.2005
  • Applied excellent problem-solving, process development, and strategic implementation skills to lead and support all areas of operations.
  • Collaborated on operational support tasks to achieve common goal.
  • Set clear goals to monitor targets and offered real-time input on performance and motivation.
  • Conducted emergency preparedness training to reduce fear, anxiety and losses that accompany disasters.
  • Created and managed knowledge base to address frequently asked questions and offer how-to guides and troubleshooting instruction.
  • Efficiently and effectively identified and solved all problems that impacted direction of business.

Customer Service Representative Specialist

Blue Cross of California
07.1991 - 10.2004
  • Offered advice and assistance to customers, paying attention to special needs or wants.
  • Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
  • Updated account information to maintain customer records.
  • Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
  • Answered customer telephone calls promptly to avoid on-hold wait times.
  • Handled customer inquiries and suggestions courteously and professionally.
  • Clarified customer issues and determined root cause of problems to resolve product or service complaints.
  • Responded to customer requests, offering excellent support and tailored recommendations to address needs.
  • Developed highly empathetic client relationships and earned reputation for exceeding service standard goals.
  • Trained new personnel regarding company operations, policies and services.
  • Sought ways to improve processes and services provided.
  • Trained staff on operating procedures and company services.

Data Entry Specialist

Blue Cross of California
08.1990 - 10.1991
  • Completed data entry tasks with accuracy and efficiency.
  • Compiled data and reviewed information for accuracy prior to input.
  • Reviewed and updated client correspondence files and database information to maintain accurate records.
  • Corrected data entry errors to prevent duplication or data degradation.
  • Sent completed entries for evaluation and final approval.
  • Resolved discrepancies in data entry activities for accurate, complete jobs.
  • Created and maintained data entry logs to track data entry activities.

Clerical Specialist

Blue Cross of California
07.1989 - 08.1991
  • Created purchase orders and tracked invoices to avoid missed or delayed shipments.
  • Completed clerical tasks such as filing, copying, and distributing mail.
  • Managed daily data entry and kept clerical information accurate and up-to-date.
  • Maintained and updated office records, both digital and physical.
  • Ordered office supplies and kept office stocked with needed resources to operate smoothly.

Education

Diploma - General Studies

Half Moon Bay High School Half

Six Sigma Yellow Belt Training Rancho - undefined

Skills

  • Client relations
  • Staff Training and Development
  • Customer Service
  • Written and Verbal Communication skills
  • Strong Analytical and Organizational skills
  • Proficient with Microsoft Excel, Word, and OneNote
  • Conference and Meeting Arrangements Time Management
  • Remote Assistance
  • Call Volume and Quality Metrics
  • Product and Service Knowledge
  • Microsoft Office
  • Policy and Procedure Adherence
  • Operational Efficiency
  • Issue and Complaint Resolution
  • Investigate Claims
  • Customer Support
  • External Audits
  • Resolving Complex Issues
  • Trend Tracking
  • System Updates
  • Customer Relations
  • Providing Feedback
  • Administrative and Office Support
  • Understanding Customer Needs
  • Document and Records Management
  • Quality Control Policies

Quote

The best way out is always through.
Robert Frost
LISA ADAMS