Summary
Overview
Work History
Education
Skills
Accomplishments
Affiliations
Timeline
AccountManager

Timika Ambrose

Detroit,MI

Summary

Dynamic Account Manager offering expertise in building partnerships, retaining key accounts and enhancing profit channels. Strong leader with proficiency in growing professional network, influencing decision-makers and devising successful strategies. Collaborative and strategic team leader with robust background in customer relationship management that allows building trustworthy relationships, surpasses demanding objectives, and delivers best in class dedicated servicing.

Overview

26
26
years of professional experience

Work History

Account Manager

Blue Cross Blue Shield of MI
Detroit, MI
06.2019 - Current
  • Assist in making decisions based on contract requirements and guidelines
  • Manage overall account strategy and consulted with clients to build strong, lasting rapport to foster account retention
  • Ensure maximum client retention and generation through relationship building and travel
  • Addressed escalated customer issues and leveraged resources to implement actionable solutions
  • Travel to multiple states to conduct member meeting
  • Support transition to guide benefit development towards assigned book of business through account benefit reviews
  • Support marketing and sales teams in implementation of new products and programs
  • Participate in internal and external benefit and claim audits
  • Liaised between account holders and various departments.
  • Analyzed account details such as usage, sales data and client comments to enhance understanding of effectiveness and client needs.
  • Improved account management by predicting potential competitive threats and outlining proactive solutions.

Manager

Blue Cross Blue Shield of MI
Detroit, MI
06.2018 - 06.2019
  • Medical Code Management-Medical Policy, Ensured the team followed the National Coding Authority standards by ensuring we maintained compliance with CMS, WHO, Federal and State Regulations
  • Ensured the staff was appropriately trained on medical terminology, ICD-10 CM and PCS, CPT, HCPCS and modifier usage to ensure accuracy during implementation
  • Managed the contracts with the American Medical Association
  • Partnered with other departments on the implementation of Medical, Benefit and Payment Policy into various claims systems
  • Participated in quarterly and annual code updates to ensure the physicians were well informed to make concise decisions
  • Supported DRG annual updates to ensure facility were reimbursed appropriately

Team Lead II

Blue Cross Blue Shield of MI
Detroit, MI
11.2007 - 06.2019
  • Reduced inventory through development of reduction planning in collaborate with aligning work intake and review with customer priorities
  • Collaborated with IT team members in decision-making processes
  • Interface with all levels of management internal and external to ensure alignment across the organization
  • Mentored and develop staff fostering effective project and time management skills
  • Distributed, prioritize, and assign work to team members as it relates to Medical, Benefit, or Payment policy
  • Delivered performance evaluations to identify areas of achievement and need for improvement related to achievement of annual Corporate Goals
  • Provided project support ensuring turnover documents and handling procedures are accurate
  • Developed and present Business Cases to substantiate funding
  • Managed maintenance changes and software applications
  • Implemented LEAN strategies resulting in 30% decrease in staff over 4 years.

Systems Analyst

Blue Cross Blue Shield of Michigan
Detroit, MI
03.2005 - 11.2007
  • Defined system scope and objectives based on understanding business processes Worked with internal business groups on process improvement projects and medical claims
  • Provided guidance regarding business implications of application development projects Coached business analyst, gather, and analyze data, provide recommendations to address and resolve business issues for customers- internal and external
  • Supporting management in a leadership capacity reviewed, analyzed, and executed projects timely
  • Assisted teammates with projects and clarifying business requirements Monitored teammates on job responsibilities Benefit interpretation and analysis
  • Attended New Group implementations and actively participated in development of benefits
  • Established specifications and coordinated production with software programmers
  • Performed system analysis, documentation, testing, implementation, and user support for platform transitions
  • Gathered requirements and performed gap analysis through design workshops with users
  • Resolved or escalated problem tickets to resolve user issues.

Group Service Representative

Blue Cross Blue Shield of Michigan
Detroit, MI
04.2002 - 03.2005
  • Researched, analyzed, and responded to service encounters received by National Accounts, HR Personnel, Union, Third Party Administrators, Agents
  • Traveled to account locations in-state and out-state to address mutual customer servicing concerns Conducted open enrollment benefit sessions for employers
  • Conducted annual benefit meeting with VPs and HR management for various National Accounts
  • Supported New Business Workgroup implementations
  • Attended seminars on robust products and services
  • Worked directly with HR Managers, Union Representatives and VPs to engage strategies to building a rapport between BCBS and the customers.

National Accounts Customer Service Representative III

Blue Cross Blue Shield of Michigan
Detroit, MI
08.1997 - 04.2002
  • Analyzed various product adhering to quality and production standards
  • Conducted internal/external research to determine needed data for claim processing
  • Executed the adjudication of professional, facility, dental, vision, RX, and hearing claims
  • Analyzed, evaluated, resolved, and responded to customer inquiries via verbal and/or written Provided responses by telephone and correspondence to account benefit questions
  • Utilized computer applications and software to access client files from the NPS mainframe
  • Mentored routine representatives to provide processing skill enhancement and apply National ASC guidelines.

Education

Bachelor of Science Health - Care Administration, Community Development

Central Michigan University
Mount Pleasant, MI
2017

Skills

  • Account servicing
  • Client relationship management
  • Strategic decision making
  • Delivery coordination
  • Benefits and Claims interpretation
  • Opportunity Identification
  • Issue Resolution
  • New Business Opportunities
  • Operational Efficiency
  • Developing Partnerships
  • Sales Meetings and Orientations
  • Team Training and Motivation

Accomplishments

  • Resolved product inconsistencies through consumer testing.
  • Managed team of 5-20 staff members.
  • Documented and resolved outdated benefit discrepancies which led to streamlined benefit administration.
  • Implement healthcare policy
  • Completed CMS knowledge courses

Affiliations

Licensed-Michigan Health and Accident Insurance Sales (DIFS) State

Commissioned Notary Public

National Management Association

Mentoring Circles Graduate 2021-2022

Timeline

Account Manager

Blue Cross Blue Shield of MI
06.2019 - Current

Manager

Blue Cross Blue Shield of MI
06.2018 - 06.2019

Team Lead II

Blue Cross Blue Shield of MI
11.2007 - 06.2019

Systems Analyst

Blue Cross Blue Shield of Michigan
03.2005 - 11.2007

Group Service Representative

Blue Cross Blue Shield of Michigan
04.2002 - 03.2005

National Accounts Customer Service Representative III

Blue Cross Blue Shield of Michigan
08.1997 - 04.2002

Bachelor of Science Health - Care Administration, Community Development

Central Michigan University

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Timika Ambrose