Sheena Benson King
Blythewood,SC
Summary
Detail-oriented professional with excellent communication, interpersonal, and creative thinking skills. Aiming to leverage my abilities to successfully fill the vacancy at your organization. Frequently praised as hard-working by my peers, I can be relied upon to help your firm achieve its goals.
Overview
21
21
years of professional experience
Work History
Project Manager – Medicare Advantage
BlueCross BlueShield of South Carolina
03.2024 - Current
- Successfully managed projects with tight deadlines and limited resources
- Coordinated team members to ensure tasks were completed on time and within budget
- Collaborated with cross-functional teams across multiple departments to achieve goals
- Provided clear direction to internal teams, setting expectations and due dates for deliverables
- Provided leadership during times of ambiguity or uncertainty while motivating the team
- Communicated effectively with all levels of stakeholders including executives
- Monitored project performance metrics to ensure adherence to quality standards
- Resolved conflicts among team members by facilitating productive conversations
- Led meetings to detail project milestones, brainstorm ideas and determine appropriate techniques to manage tasks
- Devised plans and schedules for concurrent projects to meet established deadlines
- Identified gaps across projects and strategies and recommended resolution methods.
- Adaptable and proficient in learning new concepts quickly and efficiently.
Senior Operations Analyst – Medicare Advantage
BlueCross BlueShield of South Carolina
09.2022 - 03.2024
- Analyzed data that had vital impact on the success of the operation, program, or project and that is used for developing operating strategies
- Along with identifying patterns, trends in data for business decisions by department or division leadership
- Monitored departmental methods to ensure compliance with internal measures and contract/business requirements
- Served as a liaison between the division or department and other areas on management reports, including reports concerning workload statistics
- In addition to, attending and participating in teleconference and meetings with Information Systems and vendors
- Provided periodic/consistent information to management impacted by assigned projects
- Managed/relayed project status, purpose, scope and timing
- Functioned as a project leader on work teams while assisting service areas (such as claims, customer service, appeals/grievances) with resolving compliance issues or questions
- Identified opportunities for improvement and areas/issues that can be addressed with educational initiatives as well as training staff on new initiatives
- Championed change management initiatives within the organization
- Identified opportunities for automation of manual processes using technology
- Developed training materials for new employees related to operational policies.
Customer Service Manager - Medicaid
BlueCross BlueShield of South Carolina
01.2021 - 09.2022
- Organized and managed customer service team for Medicaid Division- Provider Service Center
- Assigned work to associates within the team
- Assisted staff by providing guidance and assistance with questions and problems encountered with answering provider inquiries
- Handles escalated or sensitive customer matters
- Formed partnerships with South Carolina Department of Health and Human Services, Healthy Connections Medicaid- Provider Service Center in streamlining calls from providers relating to claims, eligibility inquires as well as fostering productive working relationships with internal teams in resolving provider concerns
- Provided friendly, knowledgeable service and support in response to customer requests
- Interviewed and onboarded customer service representatives, focusing on candidates who were quality oriented
- Monitored team's daily, weekly, and monthly performance to ensure all Service Level Agreements were met
- Manages performance to ensure that individual productivity, quality, and timeliness standards are met
- Monitors individual and team performance to ensure all customer requirements are met or exceeded
- Monitors and analyzes reports/statistics, processes, and resources to provide maximum efficiency and effectiveness for all functions
- Created and maintained reports to help business leaders make key decisions and plan their strategic operations
- Improved internal and external customer satisfaction ratings by efficiently researching, troubleshooting, and resolving escalated issues
- Evaluated the performance of various employees and encouraged team members to increase productivity
- Encouraged, facilitated, and initiated process improvements to improve daily tasks with eliminating repeated steps
- Ensured that the department was compliant with all company and government regulations
- Monitored expenses and prepares annual budget for team
- Utilized problem solving techniques to quickly resolve escalated issues from customers
- Coached and provided feedback to staff to improve performance and achieve company objectives.
Customer Service Supervisor – National Alliance
BlueCross BlueShield of South Carolina
09.2018 - 01.2021
- Supervised 14 Customer Service Representatives in providing excellent customer service to members and providers with medical, dental pharmacy related issues across the United States
- Processed ITS and non-ITS claims; researching claim deferrals; working with internal departments to resolve claims
- Elicited feedback from customer via questionnaires to assess levels of satisfaction
- Coached employees with unsatisfactory scores
- Analyze problems and concerns to make effective decisions that provide positive solutions
- Make recommendations for process improvements and efficiencies for the department
- Ensure prompt and accurate settlement of claims, appeals, and/or customer service inquiries
- Coordinates with other areas while establishing and maintaining excellent customer relations
- Evaluated employee performance and implemented incentives and team-building events to boost morale
- Oversaw process improvement and problem-solving efforts for the customer support team, including the creation of standard procedures and an escalation policy
- Outperformed team goals and worked with colleagues to implement customer service initiatives
- Coordinated department schedules to ensure maximum coverage during peak hours
- Scheduled meetings with internal professionals to address specific customer needs
- Was department's business tester, testing new products and implementations.
Enrollment Services Supervisor – Major Group
BlueCross BlueShield of South Carolina
11.2013 - 09.2018
- Directed a team of 12 employees responsible for uploading and maintaining membership files for clients through various membership systems
- Interacted with external group leaders, internal marketing, and sales team professionally by phone, email or in-person for uploading, and maintaining membership records for clients
- Developed a membership macro spreadsheet for external clients to use which reduced the amount of time for staff to enter information
- The enrollment macro reduced the average time for keying membership records from several hours to minutes
- This cost-effective method was preferred by all marketing representatives and their clients
- Organized physical files and digitized records so that authorized team members could update and retrieve them quickly
- Used these records to add, term, or update member's records
- Hired, managed, developed, and trained employees, as well as set and monitor goals, conduct performance reviews, and pay employees
- Evaluated employee performance and implemented incentives and team-building events to boost morale
- Developed a highly efficient administrative team through ongoing coaching and professional development opportunities
- Monitored 500 files and records for BlueCross BlueShield of SC clients, as well as following security procedures to prevent data breaches and misuse.
New Business Supervisor – Group and Individual
BlueCross BlueShield of South Carolina
08.2012 - 11.2013
- Conceptualized macro process to improve area’s application process; improving error rate
- Worked with a cross-functional team of business analysts, underwriters marketing, and technical support professionals to compile a comprehensive list of new application requirement specifications
- Met with internal customers on a regular basis to discuss the status of application development projects, and new government requirements
- Gathered, organized, and entered data into a database system
- Collaborated effectively with cross-functional design teams to create solutions that significantly improved overall functionality and performance on the client and new business applications
- Increased customer satisfaction by resolving issues with uploading new member information.
Senior Subrogation Specialist – Subrogation Department
BlueCross BlueShield of South Carolina
11.2006 - 08.2012
- Demonstrated a thorough understanding of and adherence to federal and state Subrogation laws
- Assisted the team with compiling and assigning accident paperwork for review
- Worked with others to brainstorm new ideas for streamlining workload
- Became area's business tester for various system upgrades and implementation
- Coached and trained all new employees.
- Provided professional services and support in a dynamic work environment.
- Used critical thinking to break down problems, evaluate solutions and make decisions.
- Developed strong communication and organizational skills through working on group projects.
- Cultivated interpersonal skills by building positive relationships with others.
- Skilled at working independently and collaboratively in a team environment.
- Managed time efficiently in order to complete all tasks within deadlines.
Subrogation Specialist
BlueCross BlueShield of South Carolina
01.2004 - 11.2006
- Managed cases provided by Local, state, federal agencies and other insurance companies relating to Subrogation cases
- Consulted with legal entities and third-party insurance companies for monetary recovery on third-party accidents
- Negotiated subrogation cases, recovering one million dollars in claims three consecutive years
- Served as liaison between legal counsel, policyholder’s attorneys and insurance companies regarding subrogation cases
- Answered calls, emails, and faxes daily responding to customer inquiries, resolving problems, and informing customers about subrogation cases Met and succeeded departmental standards by recovering over one million dollars in recovery.
ITS Refund Specialist
Subrogration, BlueCross BlueShield of SC
09.2004 - 09.2004
- Adjudicated ITS claims, applying refunds.
- Delivered timely information to insurance representatives to resolve common and complex issues.
- Compiled department-specific reports to help senior managers identify trends and improve progress.
- Followed up on denied and unpaid claims to resolve problems and obtain payments.
- Coordinated with insurance providers to verify customer's policy benefits in relation to claims.
- Monitored outstanding invoices and performed collections duties.
- Audited and corrected billing and posting documents for accuracy.
Customer Service Representative
Subrogation-Department- BlueCross BlueShield of SC
01.2004 - 09.2004
- Updated account information to maintain customer records.
- Responded to customer requests for products, services, and company information.
- Answered constant flow of customer calls with minimal wait times.
- Provided primary customer support to internal and external customers.
- Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
Education
Master’s in Human Resource Management and Master's Human Resource Development -
Webster University
Columbia, SC06.2018
Bachelor of Science in Chemistry -
University of South Carolina
Columbia, SC01.2001
Skills
- High-energy attitude
- Senior leadership support
- Quality assurance controls
- Operations management
- Computer literate
- Time management skills
- Change Management and Project Management
- Proficient with membership and claims systems: AMMS, Group Library, Qualtrics, iFlow, testing systems, ITS claims
- Operational Excellence
- Problem Solving
- Cross-functional Collaboration
- Process Improvement
- Adaptability
References
References available upon request.
Timeline
Project Manager – Medicare Advantage
BlueCross BlueShield of South Carolina
03.2024 - Current
Senior Operations Analyst – Medicare Advantage
BlueCross BlueShield of South Carolina
09.2022 - 03.2024
Customer Service Manager - Medicaid
BlueCross BlueShield of South Carolina
01.2021 - 09.2022
Customer Service Supervisor – National Alliance
BlueCross BlueShield of South Carolina
09.2018 - 01.2021
Enrollment Services Supervisor – Major Group
BlueCross BlueShield of South Carolina
11.2013 - 09.2018
New Business Supervisor – Group and Individual
BlueCross BlueShield of South Carolina
08.2012 - 11.2013
Senior Subrogation Specialist – Subrogation Department
BlueCross BlueShield of South Carolina
11.2006 - 08.2012
ITS Refund Specialist
Subrogration, BlueCross BlueShield of SC
09.2004 - 09.2004
Customer Service Representative
Subrogation-Department- BlueCross BlueShield of SC
01.2004 - 09.2004
Subrogation Specialist
BlueCross BlueShield of South Carolina
01.2004 - 11.2006
Master’s in Human Resource Management and Master's Human Resource Development -
Webster University
Bachelor of Science in Chemistry -
University of South Carolina
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