Summary
Overview
Work History
Education
Skills
Accomplishments
recognition direct reports and leaders
Timeline
Generic

Simone Outler-Petty

Owings Mills,MD

Summary

CUSTOMER SERVICE MANAGER & CONTACT CENTER SUPERVISOR:

Experienced Member Service Supervisor bringing 10+ years of experience in the Health Insurance industry focusing on Managed Care. Service-oriented and analytical mindset with flexible approach to serving members and proficient in reporting, documentation and compliance. Collaborative leader with dedication to partnering with coworkers to promote engaged, empowering work culture and excels at supporting upper management objectives by turning mandates into actionable solutions at ground level. Documented strengths in building and maintaining relationships with diverse range of stakeholders in dynamic, fast-paced settings.

Overview

17
17
years of professional experience

Work History

Member Service Supervisor (Federal Employee Program)

Versant Health
11.2021 - 10.2023
  • Led and trained a remote team of 25 Member Service Representatives, facilitating access to quality vision services for Federal Employee members and maximizing member satisfaction
  • Created and developed job aids to streamline processes to increase and optimize call center operations increasing efficiency and reducing costs, exceeding the monthly Performance Guarantee Goal of 90%
  • Conducted monthly review of reports in Quality Assurance identifying error trends to create developmental improvement plans to meet organizational goals
  • Implemented call center strategies and operation management support to ensure KPI's were met.
  • Collaborated with cross-functional teams (Quality, Utilization Management, and Training) to drive continuous improvement initiatives and achieve desired results.

Broker Service Supervisor

CareFirst BlueCross BlueShield
08.2019 - 11.2020
  • Designed and implemented individual coaching plans to empower and enhance personal development, improving the performance quality index metric of 95%
  • Resolved client complaints by pulling daily reports to identify unresolved claim inquiries nearing the threshold of 30 days and unresolved opened cases over 10 days, solidifying client retention, and achieving high Net Promoter Score of 70
  • Coached and mentored a team of 20 Account Representatives across 2 regions (MD/DC) to meet key performance indicator metrics in customer satisfaction, correspondence response timeliness, and case resolution in managed care
  • Maintained 60+ Direct Broker service accounts for Medical and Pharmacy products for Small Business lines specializing in less than 200+ (Risk and Self-Insured) businesses, by fostering solid client relationships and operating cross-functionally with Sales, Claims, and Marketing
  • Conducted monthly and quarterly client-facing meetings to discuss client group performance, error trends, and procedure changes to reduce escalations, resulting in 90% client satisfaction
  • Administered 90-day performance management improvement plans by diagnosing call handling inefficiencies using scorecards, call monitoring, and coaching results surpassing associate performance goal of 96%.

Operations Service Supervisor (Government Programs)

CareFirst BlueCross BlueShield
12.2016 - 08.2019
  • Conducted claims configuration analysis and audited claim review
  • Spearheaded the development of new standard operating procedures for department policies on a dedicated SharePoint, resulting in a 35% improvement in process efficiency and structural organization
  • Implemented a daily inventory review process and exceeded monthly timeliness goals of 98% for resolving unresolved claim inquiries, resulting in high customer satisfaction ratings.
  • Streamlined operations for increased efficiency through regular process reviews and implementing necessary changes.
  • Increased team productivity by implementing efficient workflows and setting clear expectations for staff members through 'Blue Crew', a team morale program to recognize and incentivize associates meeting and exceeding KPIs
  • Reduced employee turnover by fostering a positive work environment and providing ongoing feedback to staff members.

Customer Service Supervisor (Individual Market)

CareFirst BlueCross BlueShield
03.2013 - 03.2015
  • Trained 30 Customer Service Advocates in claims and benefits assisting members with their health plan selections through the Health Insurance Marketplace for the Mid-Atlantic region (M.D., DC, and V.A.), improving client experience in health plans with proficiency in HSA, HRA, and CDH plan types
  • Appeared as CareFirst representative for client meetings with regulatory agency DC commissioner and Maryland Insurance Administration
  • Served as a liaison in vendor management for (Teleperformance), improved communication transparency by conducting monthly client-facing and onsite meetings to increase efficiency and optimize vendor team performance, achieving 85% service level agreement.
  • Enhanced team productivity through regular coaching, feedback, and performance evaluations.
  • Improved customer satisfaction by addressing and resolving escalated issues promptly and professionally.

Customer Service Specialist

CareFirst BlueCross BlueShield
06.2010 - 03.2013
  • Co-managed a team of 15 Customer Service Associates to handle inbound calls and process correspondence and grievances for members resulting in 95% customer survey satisfaction
  • Analyzed assigned complex benefit and claim inquires by completing written communication to convey the determination of approvals/denials of grievances ensuring compliance with regulatory agencies such as the [Maryland Insurance Administration, District of Columbia Commissioner and Virginia Bureau of Insurance]
  • Identified claim defects with product errors and submitted to technical support for resolution, identifying improper mapping and proposed work-arounds until fixes were implemented
  • Investigated claim overpayment, claim recovery for third-party involvement applicable to various Provider payer types
  • Developed a tracking system to manage the workflow of inbound correspondence and disseminate to employees, minimizing unresolved claim inquiries by 25% in FACETS database.
  • Reduced response time for customer inquiries by streamlining communication processes.

Customer Service Representative II

CareFirst BlueCross BlueShield
03.2007 - 06.2010
  • Adjudicated simple claims for professional providers and for institutional providers sent to completed
  • Processed and keyed simple claims per HCFA 1500 claim forms using appropriate ICD-9 codes and used claim check, if mapping received an error.
  • Enhanced customer satisfaction by promptly addressing concerns and providing accurate information.
  • Developed strong product knowledge to provide informed recommendations based on individual customer needs.

Education

BA -

University of Maryland- UMUC -Global Campus
01.2026

Skills

  • Leadership and team management
  • Claims processing and adjudication
  • Compliance and regulatory
  • Process improvement and optimization
  • Client service and technical support
  • Workflow and system enhancements
  • Quality improvement and corrective action planning
  • Strategic thinking and problem-solving
  • Healthcare industry knowledge and experience
  • Benefits Analysis
  • Nice/InContact
  • Verint
  • PeopleSoft/Dayforce
  • Compliance Expertise
  • SalesForce
  • FACETS/HSP/CSP
  • SQM
  • CRM
  • Legacy AS/400
  • Aspect

Accomplishments

Top Supervisor 2017 in FEP

Service Excellence Award

Awarded TOP TEAM in SQM

recognition direct reports and leaders

  • Associates- Direct reports, This is a response to your eloquent annual review feedback, but I wanted to share the impact of your sincere and so thoughtful words of encouragement, support (my biggest work cheerleader) and words of wisdom. ………Thank you for the kind words, I sincerely appreciate your support going into this new chapter. (Lisa Brown 2022),
  • I really couldn't have done my position to the level y'all requested without the guidance you provided. You pushed me to look at things in a different way especially when it came to my QA points. (Sarah Nelson 2022),
  • Thank you so much for your kind words. The opportunity to genuinely help people is where my passion lives. Being able to provide value in the process is where my fulfillment intersects with that passion. To be recognized and valued as a result, is an honor I don't take for granted. (Tatiana Francis 2022),
  • I really appreciate having a manager like you, your support and thoughtfulness you display is out of this world. Simone you really set the tone for having such a positive team culture. (Arthesia Copeland 2019),
  • Aww!!! There are no words for what you do! You are amazing, patient, kind, understanding, and more important a true leader. Thanks for all you do!!! (Adrienne Davis 2018)
  • Leadership-Managers, Simone works at improving productivity without compromising Quality. Her ability to coach, educate and inspire associates on the team has allowed us to have the lowest inventory numbers in Service at Red Run. Although the processes and procedures have changed many times over the last two years, she continues to be flexible to meet the needs of the Department therefore she exceeds this goal. (Patricia Gibbons 2011),
  • I would like to recognize Simone Outler-Petty for her continued support in assisting me with Facebook inquiries. Simone is always there when I need her as we have a two-hour window to respond to these inquiries. Simone is the perfect team-player, never complains, and is always up for the challenge. (Marvalyn Threat 2013),
  • Simone has shown exceptional skills and capabilities at conveying the corporate agenda and supporting management through her dedication and hard work. She recognizes areas of need and proactively addressed those, enabling management to empower her to work independently and collaboratively. (Bryan K Wilson 2018),
  • Simone's organization, dedication and positive attitude has allowed the team to buy-in to the changes she has made within the FEP Department. She is a leader that is firm, direct, fair, and motivates her team to do their best. The changes she has made has allowed us to increase our retention rate significantly, allowing us to retain more quality associates for the FEP program. (Jeri Dickerson 2019),
  • Simone has been successful with providing the necessary foundation and support for her staff. She has taken quite the initiative in creating job aids, coaching staff, conducting trainings, and suggesting employee recognition programs. Simone never misses a beat when it comes to maintaining a high performing team. Her team continues to exceed the quality expectation monthly. (Kiera Scott 2022)

Timeline

Member Service Supervisor (Federal Employee Program)

Versant Health
11.2021 - 10.2023

Broker Service Supervisor

CareFirst BlueCross BlueShield
08.2019 - 11.2020

Operations Service Supervisor (Government Programs)

CareFirst BlueCross BlueShield
12.2016 - 08.2019

Customer Service Supervisor (Individual Market)

CareFirst BlueCross BlueShield
03.2013 - 03.2015

Customer Service Specialist

CareFirst BlueCross BlueShield
06.2010 - 03.2013

Customer Service Representative II

CareFirst BlueCross BlueShield
03.2007 - 06.2010

BA -

University of Maryland- UMUC -Global Campus
Simone Outler-Petty