Monique M. Doss
Chester,PA
Summary
Proficient in managing Member/Provider Service teams, ensuring optimal performance and adherence to service level agreements. Experienced in resolving complex member and provider issues, facilitating effective communication and relationship-building. Committed to continuous improvement through process analysis and team training.
Overview
34
34
years of professional experience
Work History
Procedural Analyst
AmeriHealth Caritas Family of Companies
Philadelphia, Pennsylvania
2016.07 - 2025.11
- Managed life cycle of enterprise operations policies and procedures, ensuring comprehensive documentation.
- Contributed to development of policies to maintain accuracy and consistency throughout the enterprise.
- Utilized document management system to organize company files, keeping up-to-date and easily accessible data.
- Facilitated training sessions for staff on data analysis tools and techniques.
- Created detailed reports on operational efficiencies for management review.
- Reviewed administrative manuals for clarity and verified cited research sources for compliance.
- Participated in collaborative efforts to enhance effectiveness of operational guidelines.
Member/Provider Services Supervisor
AmeriHealth Caritas Family of Companies
Philadelphia, PA
1999.02 - 2016.07
- Manage day-to-day operation of Member/Provider Service teams
- Managed over 20 direct reports to maximize potential and achieve team goals
- Managed team performance by ensuring all representatives met or exceeded service level agreements within the established performance standards.
- Facilitate monthly team meeting and weekly huddles to ensure representatives' knowledge of plan benefits
- Oversee the dissatisfaction liaisons to ensure proper investigation and resolution of complaints in compliance with IBC and NCQA regulations
- Handled client issues directly to cultivate strong business relationships with internal departments and external customers
- Recommended improvements through analysis of processes, procedures, and best practices
- Ensure all system related upgrades and implementations are implemented efficiently
- Responsible for creating and executing user acceptance test scripts
- Prepared comprehensive documentation and summarized reports for all investigations and recommendations for staff development coaching and mentoring.
Customer Service Associate
AmeriHealth Caritas Family of Companies
1998.06 - 1999.02
- Managed customer inquiries across multiple business lines, ensuring timely and accurate resolutions
- Handled 60-65 incoming calls daily across different business lines
- Investigated and analyzed provider and member claim inquiries to identify and resolve issues effectively
- Assisted in training new customer service representatives, enhancing team readiness and service quality
- Instrumental in the development of new member service representatives
- Provided in-depth knowledge of plan benefits and expansion area plan benefits
- In-depth knowledge of AmeriHealth Family of companies plan benefits & procedures
- Knowledge of Pennsylvania State Medicaid systems
Enrollment Specialist
AmeriHealth Caritas Family of Companies
1992.05 - 1998.06
- Verified and entered enrollment demographic information for enrolled and dis-enrolled members, ensuring data accuracy and compliance
- Ensured that all enrollment records are reconciled in accordance with Pa State enrollment databases
- Reconciled Pennsylvania HMO-10 exception report and accurately documented discrepancies
- Generated monthly statistical reports and logs to track enrollment trends and support departmental decision-making
- Met established deadlines set forth by departmental production schedules, contributing to overall team efficiency and workflow
Education
Graduate of the KMHP Super Sup Series -
2008-01
Associates Degree - Liberal Arts
Widener University
1993-01
Course of Study - Certified Phlebotomist
Delaware County Community College
1988-01
Course of Study - Medical Terminology
Chester High Adult Evening School
Chester, PA1984-01
High School Diploma -
Chester High School
Chester, PA1983-01
Skills
- Managed care knowledge
- Medicaid policy expertise
- PA State System
- Attention to detail
- Effective communication
- Training facilitation
- Performance management
- Policy writing
- Document management
- Microsoft office
- Sharepoint
- Scion & Denta Quest Portals
- Multiple priorities management
- Team Leadership
- Adaptable team player
References
Available upon request
Timeline
Procedural Analyst
AmeriHealth Caritas Family of Companies
2016.07 - 2025.11
Member/Provider Services Supervisor
AmeriHealth Caritas Family of Companies
1999.02 - 2016.07
Customer Service Associate
AmeriHealth Caritas Family of Companies
1998.06 - 1999.02
Enrollment Specialist
AmeriHealth Caritas Family of Companies
1992.05 - 1998.06
Graduate of the KMHP Super Sup Series -
Associates Degree - Liberal Arts
Widener University
Course of Study - Certified Phlebotomist
Delaware County Community College
Course of Study - Medical Terminology
Chester High Adult Evening School
High School Diploma -
Chester High School