NicQuela Boyd
Hoover,AL
Overview
10
10
years of professional experience
Work History
Benefit Analyst II
Blue Cross Blue Shield Of Alabama
07.2021 - Current
- Implements health, pharmacy and dental benefits for Merit, Small, Large, Credence and Hospital group plans
- Facilitated new hire training for new BGA team members on policies and procedures and offered insight into best ways to manage job tasks and duties, in person and virtually
- Developed training materials and lesson plans for newly hired BGA Benefit Analysts
- Researches and resolves issues and inquiries from claims department regarding health benefits and claims processing
- Creates employee education manuals to improve understanding of benefit changes to meet timeliness goals and increase accuracy
- Conducted refresher training for Benefit Analysts regarding area processes
- Explains benefits to sales representatives and groups administrators in easy to understand terms in order to educate each on changes with policy via email
- Effectively communicates via phone, chat, and email with all levels of staff, internal and external
- Serves on BGA Incentive Workgroup for investment in associates
- Prepares Summary Plan Descriptions (SPD) for group members
- Mentors peers on BGA policies and procedures
- Strong interpersonal communication and organizational skills
- Exceeded expectations on most recent Performance Evaluation
- Builds relationships with internal and external customers to foster quality service
- Working knowledge of Microsoft Word, Excel, and PowerPoint
- Working knowledge of claims systems such as MRO, BMW, BIR, Navigator, BMX, XPressions, and GEMS
- Understanding of
Team Leader
Blue Cross Blue Shield of Alabama
11.2016 - 07.2021
- 2017 World Class Team Leader
- Independently researched all aspects of projects and processes to make solid and substantiated recommendations to management
- Conducted quality-related reviews of agent performance, evaluating against client and internal quality standards to ensure proper call and transaction handling. This includes call monitoring, review of data entry/transactions processed, and evaluation of any other performance metric that may impact quality (i.e. handle time, speed of answer, etc.)
- Provided value added ongoing feedback to manager and peer Team Leaders on how to improve call handling and increase knowledge of process and procedures to drive quality improvement in the division
- Developed and facilitated department wide training to all levels of management and associates regarding newly implemented changes in the area
- Ensured superior customer experience by addressing customer concerns, demonstrating empathy, and resolving problems using First Call Resolution
- Customer Service Department HIPAA DiPR
- Provided support to management with resolving escalated issues by prioritizing and addressing members directly through outbound calls on a daily basis
- Performed root cause analysis and make recommendations for addressing identified deficiencies or improvements to business processes using available data
- Developed and managed “First Call Resolution” program to with successful participant improvement and strides towards meeting divisional goals
- Performed data analysis for “One Call to Resolve” program identifying opportunities to develop 13 CSRs and improve member experience
- Participated in and supported the 'One Call to Resolve' program in identifying and acting on opportunities that improve the quality and value of the service provided to clients and employees by developing customer service representatives
- Developed and facilitated various presentations to peers and management to drive department performance
- Created specific work plans to assist representatives to reach individual targeted goals which successfully improved mentee performance by 11%
- Working knowledge of Microsoft Word, Excel, and PowerPoint
- Working knowledge of contracts, claims and inquiry processing across multiple lines of business
- Planed, organized, coordinated, and presented in team and joint staff meetings regarding area changes and progress
- Effectively communicated via phone, chat, and email with all levels of staff, internal and external
- Used research and analytical thinking to identify potential area problems and resolutions independently
- Served as a liaison between BCBSAL representatives, pharmacy department and medical review team regarding medical review guidelines by email and phone
- Collaborated with manager to achieve area goals
- Extensive knowledge of products sold and services provided by Blue Cross and Blue Shield of Alabama
- Exceeded service and quality standards every review period
- Strong interpersonal communication, customer service, and organizational skills
- Worked with Digital Marketing to create prototypes of new designs and training materials
- Used diverse teaching materials and motivational approaches to reduce learning gaps and instruct customer service representatives
Customer Relations Specialist, District Office Support Leader
Blue Cross Blue Shield Of Alabama
05.2013 - 11.2016
- Provided accurate and appropriate information in response to customer inquiries while maintaining low talk time
- Enrolled members in health care plans during company wide open enrollment
- Coached members about health care services available on health policy
- Assisted members with finding providers in their area, helping to identify and close gaps in care
- Ensured superior customer experience by addressing customer concerns, demonstrating empathy, and resolving problems using First Call Resolution
- Assigned to Support Leader Pool to assist peers with complex situations regarding claims payment and processing, benefits, and/or eligibility
- Coached representatives via phone regarding benefits and claims to help members
- Educated representatives on how to resolve complex situations
- Assisted members with available health and wellness programs,such as Baby Yourself, Health Quotient, and any other group specific programs
- Assisted management with resolving escalated issues by prioritizing and addressing members directly through outbound calls on a daily basis
- Used analytical thinking to help resolve difficult and stressful situations for members regarding claims and benefits
- Cross trained in areas such as Provider, Large Group, and General Electric
- Served as a liaison between BCBSAL representatives, Pharmacy Department and medical review team regarding medical review guidelines by email and phone
- Exceeded service and quality standards every review period
- Selected by manager for Aspire to Excellence program
- Proficient in MRO/CIS, DORS, INFOPAC, PRIME and BOL
- Proficient in Microsoft Word, Excel, and Powerpoint
Education
Bachelor of Science - Healthcare Management
University of Alabama at Birmingham
Birmingham, AL2012
Timeline
Benefit Analyst II
Blue Cross Blue Shield Of Alabama
07.2021 - Current
Team Leader
Blue Cross Blue Shield of Alabama
11.2016 - 07.2021
Customer Relations Specialist, District Office Support Leader
Blue Cross Blue Shield Of Alabama
05.2013 - 11.2016
Bachelor of Science - Healthcare Management
University of Alabama at Birmingham
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