TONYA ANDERSON
Durham,NC
Summary
Highly skilled Business Process Expert with a strong background in analyzing, optimizing, and implementing business processes to enhance efficiency and productivity. Deep understanding of project management principles coupled with problem-solving abilities and strategic planning skills. Proven track record in driving process improvements resulting in operational excellence. Notable for identifying areas for improvement and executing change initiatives that support business objectives.
Overview
11
11
years of professional experience
Work History
Business Process Advisor
BLUE CROSS AND BLUE SHIELD OF NC
Durham, NC
09.2013 - 08.2024
- Led the Siebel Service 1st Sunsetting Project (1/1/24) by achieving no inventory across all departments by 3/31/24 to avoid licensing fees
- Partnered with Customer Experience Team to develop Customer Service Feedback Surveys for the Personalized and Retail Service Teams to capture real-time feedback
- Developed XMD Dashboards by collaborating with Management to establish Quality, CAA Mandate Letters, and Silent Calls to assist in auditing, mandatory provider letters, and call avoidance
- Collaborated and partnered with Directors to create PowerPoint Frontline Focus Presentations created for weekly/monthly Go to Green Project updates
- Collaborated extensively across Knowledge Management, Customer Experience, Service Operations, and Quality departments to develop decision tree job aids, improving call efficiency
- Employs continuous process improvement to define the problem, assess the current state, analyze root cause, recommend process improvements, and closely monitor outcomes
- Operations and Member Experience Excellence Awards Nominee 2023.
Process Change Consultant Associate
BLUE CROSS AND BLUE SHIELD OF NC
Durham, NC
09.2019 - 03.2022
- Presented research findings via process mapping from member escalations to Executive Leadership Team that led to major process improvements to include digital id cards, Blue Connect payments, revision of ABA benefits, and removal of the Away from Home Care Program
- Coordinated with the Divisional Learning Department to facilitate the Customer Satisfaction Journey Map presentation to 50+ new hire classes for incoming customer service representatives for preparation and awareness of our Customer Satisfaction Department
- Conducted monthly quality reviews for the Customer Satisfaction and HICS Teams to evaluate the Customer Escalation Analysts’ performance and customer experience based on established policies and procedures
- Created curriculum for Customer Satisfaction Onboarding Process and Handbook
- Created Standard Operation Process for HICS Case Escalation Process and SLA.
Senior Customer Escalation Analyst
BLUE CROSS AND BLUE SHIELD OF NC
Durham, NC
11.2016 - 09.2019
- Trained incoming Senior Customer Escalation Analyst to ensure successful transition to the responsibilities of the role
- Participated in Trending Analysis Project with Compliance, Treasury Operations, Reconciliation-Delinquency, and Sales to ensure internal and external information is current to provide our employees and members with accurate information
- Partnered with HICS Management to develop and present the Quality Program for incoming ACA Enrollment Specialist
- Created and maintained the quality rotation schedule for the Customer Satisfaction and HICS Team
- Performed root cause analysis on escalated cases, including a thorough point mapping and other lean six sigma tools.
Customer Solution Expert
BLUE CROSS AND BLUE SHIELD OF NC
Durham, NC
09.2013 - 11.2016
- Analyzed and resolved written member escalation from the Department of Insurance (DOI) that resulted in participation in the DOI Audit Project
- Collaborated with Management to create the Quality Program, template, and updating the Customer Escalation Handbook for the Customer Satisfaction Team
- Functioned as a Subject Matter Expert for Health Care Reform training for existing employees.
Customer Service Professional
BLUE CROSS AND BLUE SHIELD OF NC
Durham, NC
- Utilize probing and creative problem-solving methods to resolve foundational customer inquiries on first contact
- CEO Customer Service Award Nominee
- Identified and obtained information and records from customers, members, providers, and/or employer groups to correct/update information, claims, and membership records when necessary
- Achieved High or Top Contributor each year by exceeding performance metrics, accountability for results, information-driven decision making, and ethics and compliance.
FEP Claims Team Leader
BLUE CROSS AND BLUE SHIELD OF NC
Durham, NC
- Managed claim inventory daily; Deferral Inventory, Common Claims Front End (FormWare/SourceHOV), AWR (Awaiting Review Claims), Escalated Claims, and Provider Services Unit Spreadsheets.
Management Associate Program
BLUE CROSS AND BLUE SHIELD OF NC
Durham, NC
- Created development plans and provided coaching to help employees achieve quality and production goals
- Delivered monthly performance reviews for employees to continue achieving goals or create an action plan for improvement.
Customer Service Specialist/Technical Support
BLUE CROSS AND BLUE SHIELD OF NC
Durham, NC
- Functioned as a Subject Matter Expert for Individual Business and State Health Plan lines of business supporting the trainers on developing skills in the formal training program
- All Star Award received for training staff of 15-20 in Arkansas who achieved exceeding contract goals.
Education
Skills
- Quality Auditing
- Continuous Process Improvement
- Coaching & Development
- Program Management
- Customer Service
- Escalation Management
- Call Center Operations
- Facilitation
- Customer experience
- Workflow Optimization
- Lean Six Sigma
- Process Documentation
- Operational Excellence
- Innovation and Creativity
- Process Mapping
- Data-driven decision-making
- Business Analysis
- KPI Tracking
- Strategic Planning
- Gap analysis
- Procedure Development
Tools and Technology
- Salesforce
- Prime Therapeutics
- Genesys Cloud
- XM Discover
- Facets
- Tableau
- Qualtrics
- Microsoft (Office + Excel + PowerPoint + Outlook + Teams + OneNote)
Personal Information
Title: BUSINESS PROCESS ADVISOR
Timeline
Process Change Consultant Associate
BLUE CROSS AND BLUE SHIELD OF NC
09.2019 - 03.2022
Senior Customer Escalation Analyst
BLUE CROSS AND BLUE SHIELD OF NC
11.2016 - 09.2019
Business Process Advisor
BLUE CROSS AND BLUE SHIELD OF NC
09.2013 - 08.2024
Customer Solution Expert
BLUE CROSS AND BLUE SHIELD OF NC
09.2013 - 11.2016
Customer Service Professional
BLUE CROSS AND BLUE SHIELD OF NC
FEP Claims Team Leader
BLUE CROSS AND BLUE SHIELD OF NC
Management Associate Program
BLUE CROSS AND BLUE SHIELD OF NC
Customer Service Specialist/Technical Support
BLUE CROSS AND BLUE SHIELD OF NC