Care Senior Associate Resume Samples
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Care Senior Associate Resume Samples
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JM
J McClure
Judge
McClure
666 Kenyatta Causeway
Los Angeles
CA
+1 (555) 703 6085
666 Kenyatta Causeway
Los Angeles
CA
Phone
p
+1 (555) 703 6085
Experience
Experience
Detroit, MI
Care Senior Associate
Detroit, MI
Ledner-Ullrich
Detroit, MI
Care Senior Associate
- Initiating tasks in order to make improvements to current workflows that parallel with CBH’s mission
- Adheres to productivity and workload management goals and accurately reports
- Developing an action plan for professional development
- Provide participants with names and phone numbers of nearest providers
- Maintaining a high level of working knowledge about CBH’s customers and products
- Adheres to quality assurance standards and all case management policies and procedures, especially those related to confidentiality
- Assisting less seasoned peers by helping answer questions
Houston, TX
Customer Care Senior Associate
Houston, TX
Witting-Lind
Houston, TX
Customer Care Senior Associate
- Manage customer escalations on the highest priority and work with Account / sales manager for solutions and update mgt
- Engage with other departments - e.g: Sales, logistics, Technical Support etc to work on process improvement
- Builds and maintains a broad network of information sources. Works with home office, regional/ non-regional business units, the public, vendors and agencies
- Develop and maintain a working relationship with other business units involved with Insurance Department complaints
- Negotiates with customer using various tools and techniques provided by Dell
- Provides direct advice and guidance to customers in navigating Dell's website and internal policies and procedures
- Works with various departments to meet maintenance services sales goals through constant process alignment
present
Chicago, IL
Pre-certification Care Senior Associate
Chicago, IL
Gleichner Group
present
Chicago, IL
Pre-certification Care Senior Associate
present
- Receive request for authorization from hospitals, providers, members and vendors; Meet service level goals (e.g., Grade of Service, Average Handle Time, Average Speed to Answer, abandonment rate)
- Notifies responsible parties prior to initiation of denial letter and ensures that member and responsible party understand details of the letter and the appeals processes to follow
- Maintain benchmark standards for TAT (Turn Around Time) as established by the organization
- Review authorization requests and make determinations on correct authorization process (i.e. auto approve, refer to Precert Nurse or Medical Director)
- Completes review of non authorized medical claims
- Proficient knowledge of departmental policies and procedures; knowledge of Medicare, HIPPA and NCQA
- Other duties as requested
Education
Education
Bachelor’s Degree in Mental Health Field
Bachelor’s Degree in Mental Health Field
University of California, Berkeley
Bachelor’s Degree in Mental Health Field
Skills
Skills
- Substantial knowledge of Microsoft Office including SharePoint, Outlook, PowerPoint, Excel and Word
- Able to work in a dynamic, fast-paced team environment and to promote team concepts
- Excellent interpersonal and communications skills with nursing staff, physicians, nurse practitioners and other health workers involved in the care of a member
- Responsible for meeting Quality metrics and performance guarantees
- Maintain a professional and positive image to internal and external customers
- Partner with coaches, clinical leads and clinical supervisors to provide seamless service across departmental roles
- Provide immediate escalation of crisis calls to the appropriate resources and support triage process, assisting coaches as necessary
- Interface with multiple computer systems, often simultaneously, as well as matrix partners and resources to achieve first call resolution for customers
- Provides follow-up calls to participants to assess level of services, alert to available web services, and completes outcomes follow-ups, as necessary for the outbound campaign
- Initiates the Inquiry and Complaint process
10 Care Senior Associate resume templates
Read our complete resume writing guides
1
Customer Care Senior Associate Resume Examples & Samples
- Review and distribute cross functional information
- Directs customer calls to the proper location and department
- Provides options for those customers who want to return Dell products
- Negotiates with customer using various tools and techniques provided by Dell
- Acts as a liaison between the customer and manufacturing, sales, technical support, and financial services
- Deescalated customers situation
2
Customer Care Senior Associate Resume Examples & Samples
- E-mail and phone communication to support sales service provided to customers
- Advise and support a group of consumer, small & medium business and public and large enterprise clients to their highest satisfaction
- Delivery of a positive customer experience, to solve situations when orders do not meet the customers' expectations
- Enhancing the value of the positive customer experience through the knowledge, information and advice given
- Work in a dynamic environment of multinational teams and with an opportunity of connecting to different people from various countries every day
- Use your own initiative to find new solutions for unusual or problematic situations regarding the customer’s order to ensure the best experience with Dell
3
Customer Care Senior Associate Resume Examples & Samples
- Managing issues related to Order Status, Missing Wrong Damage or Return, and customer escalation both phone and email systems
- Interact and work with other Region Customer Care teams and the APJ PMO teams when the need arises
- Responsible for setting realistic customer expectations, and meeting or exceeding these expectations
- Verify and investigate into customer's complaints and drive for resolution within specified time frames
4
Care Senior Associate Resume Examples & Samples
- Excellent telecommunications and customer services skills
- Ability to multi-task and prioritize tasks appropriately and effeciently
- Proficient knowledge and understanding of Microsoft Office, Excel, (proficient use of CCMS preferred but not required)
- Working knowledge of automated systems/telephone
- Works well in a teamwork environment
5
Care Senior Associate Resume Examples & Samples
- The primary responsibility of the Advocate role is answering calls from customers. The majority of the day will be answering inbound calls from customers looking to access, understand, or utilize services
- Assisting less seasoned peers by helping answer questions
- Participating in staff meetings and in-service seminars
- Initiating tasks in order to make improvements to current workflows that parallel with CBH’s mission
- Developing an action plan for professional development
- Working with matrix partners, leadership and peer group to help ensure processes are up to date and effective
- Participating in team building activities to boost morale
- Completing additional assigned projects and tasks
- Maintaining a high level of working knowledge about CBH’s customers and products
6
Care Senior Associate Resume Examples & Samples
- Review eligibility, liability, and coverage information on new cases and on regularly scheduled follow-up; provide communication of benefit plans for cases on an as-needed basis; periodically update this information
- Review and direct claim payment for cases that have a treatment plan in place, and that are being managed by the coordinators
- Consult on cases moving into management regarding treatment plan funding based on case management philosophy. Periodically review cases during management according to guidelines
- Research and analyze insurance, claim payment and nonpayment issues and problems
- Provide insurance training for new personnel and conduct insurance inservice programs as needed
- Adheres to quality assurance standards and all case management policies and procedures, especially those related to confidentiality
- Adheres to productivity and workload management goals and accurately reports
- Accurately and timely assessment of provider’s contract to determine coverage and benefit availability
- Communicates professionally with all internal and external customers, peers, matrix partners
7
Care Senior Associate Resume Examples & Samples
- Persuasively engaging customers in coaching programs based on identified need information gained from multiple sources
- Listen and stay focused on the member while using various systems to verify and document data
- Register participants in the appropriate system(s) and opens case files for the Integrated Personal Health Team, assisting participants with all requests for resources and services
- Ensure all customer information is maintained accurately and confidentially
- Schedule appointments with wellness coaches by matching participant needs and coach availability/expertise
- Quoting eligible benefits as well as service and process explanation
- Provide participants with practitioner referrals according to contract, specialty, and/or geographic
- Education based on the participant’s need as well as referrals to external resources including, but not limited to mental health practitioners in the community, client elected benefits, community supports
- Provide immediate escalation of crisis calls to the appropriate resources and support triage process, assisting coaches as necessary
- Interface with multiple computer systems, often simultaneously, as well as matrix partners and resources to achieve first call resolution for customers
- Provides follow-up calls to participants to assess level of services, alert to available web services, and completes outcomes follow-ups, as necessary for the outbound campaign
- Initiates the Inquiry and Complaint process
- Partner with coaches, clinical leads and clinical supervisors to provide seamless service across departmental roles
- Maintain a professional and positive image to internal and external customers
- Take on additional tasks as assigned while remaining productive and supportive to the team and the incoming volume
- Flexibility to adapt to changing workflows, in a fast paced environment
- Responsible for meeting Quality metrics and performance guarantees
- Demonstrates a complete awareness and understanding of the responsibilities and workflows of the various departments within the site. Collaborates with appropriate matrix partners
- Participates and actively contributes in staff meetings and in-service seminars. Represents the advocate perspective in work-groups and projects
- Bachelor’s degree in mental health field or psychology/social work, marketing, communication, or related field preferred
- Bi-lingual preferred
- Confidence to voice creative ideas and think outside the box, not only for the benefit of the caller but the team as well. Strong analytical skills
- Superb interpersonal communication and leadership skills with capacity to project warmth and empathy
- Two years of experience in a mental health, social service, healthcare setting preferred, previous customer service experience preferred
- Effective organizational skills and ability to manage multiple tasks
- Technical knowledge of automated databases, tracking systems, spreadsheet applications. Excellent PC skills
- Experience in a service-focused, fast-paced environment
- Ability to delineate complex service and benefit issues. Ability to judge severity of crisis based on scripted assessment questions and delegate to care manager’s staff when necessary
- Ability to maintain a high level of working knowledge on products and services available
- Ability to match educational materials to participant needs
- Ability to recognize and follow up on complicated service issues
8
Care Senior Associate Resume Examples & Samples
- Excellent knowledge of group health benefit plans
- Good analytical, evaluation, organizational and communication skills
- Ability to clearly communicate information to case managers for applications in case management
- Minimum of five years of progressively responsible group health insurance positions preferred
- Customer service skills and experience preferred
- Basic knowledge and understanding of CIGNA products and services, CIGNA technology and telephone systems
- Ability to work independently and make independent decisions and ability to work unsupervised on special projects
- Ability to adapt and be flexible within fast-paced dynamic environment
- Ability to adapt to a high volume environment
- Ability to function as part of a team
- Demonstrated ability to participate on/lead projects and workflow improvement initiatives
- Ability to act as change agent to support organization’s objectives
9
Care Senior Associate Resume Examples & Samples
- Stay within the role for a minimum of 1 year
- Actively engage with customers in a positive, professional and empathic manner = 100 % goal
- Provide high quality customer service = no more then six off-target call scores within a full calendar year (pro-rated)
- Follow appropriate workflows and HIPAA guidelines = 100% goal
- Adhere to a pre-determined daily schedule = 92% goal
- Be on time with minimal unexcused absences = Adhere to Cigna Standard Policies
- Be professional and communicate effectively with internal and external matrix partners = receives consistent positive feedback
10
Care Senior Associate Resume Examples & Samples
- Provide high quality customer service
- Adhere to a pre-determined daily schedule
- Be on time with minimal unexcused absences
11
Care Senior Associate Resume Examples & Samples
- Interfaces and assists all clinical teams in locating members admitted at aligned facilities
- Conduct daily call to review member admissions
- Answers questions regarding referral process
- Interfaces with Clinical teams for collecting information and submitting to the appropriate responsible parties
- Working knowledge of automated systems/telephone systems
12
Customer Care Senior Associate Resume Examples & Samples
- Researches customer information and inputs data into designated system. Manages correspondence and notifications within targeted time frames to meet Department of Labor and Customer Performance Guarantees
- Provides a positive customer experience to all clients and customers. Actively listens to customers, probes for clarification, and provides consultative guidance to meet customer needs
- Inputs intermittent Family Medical Leave (FML) time received into designated system, compares certification information against Business Requirement Documents, and renders determination
- Collaborates and consistently communicates with leadership team to mitigate risks and escalate issues beyond scope of current duties as needed. Provides feedback regarding standard operating procedures and processes to drive enhanced continuous improvements
- 1 year minimum of customer service or call center experience
- High School Diploma or GED required; Bachelor's degree strongly preferred
- Basic knowledge of Microsoft Office applications is required
- Effective interpersonal, written, and verbal communication skills
- Strong critical, analytical and investigative skills; ability to gather information, analyze facts, and draw conclusions
- Proven skills in positive and effective interactions with challenging customers and complex service issues
- Experience in effectively meeting/exceeding individual professional expectations and team goals
- Ability to manage multiple tasks in a fast-paced, customer-centric environment
13
Care Senior Associate Resume Examples & Samples
- Determine authorization requirements based on company policy, member benefit grid and provider status
- Processes denials including correspondence sent to families, members, facilities and applicable contracted providers
- Notifies responsible parties prior to initiation of denial letter and ensures that member and responsible party understand details of the letter and the appeals processes to follow
- Completes review of non authorized medical claims
- Professional demeanor and the ability to work effectively within a team or independently
- Flexible with the ability to shift priorities when required
- Maintains regular and acceptable attendance at such level as is determined at the employer’s sole discretion
- High School Diploma and 3-4 years experience in a managed care environment
- Must be proficient in medical terminology, CPT and ICD-9/ICD-10 coding
14
Customer Care Senior Associate Resume Examples & Samples
- Responds to customer service inquiries regarding company products, features and/or services
- Maintains ownership of customer issues directing customer to the appropriate agent when required
- Supports sales team by developing and maintaining positive customer relations with clients/customers, which can substantially affect service and/or product revenue(s)
- Works with various departments to meet maintenance services sales goals through constant process alignment
- Works with customers and/or distributors to understand and document customer issues
- Primary focus will be on post-sales service to customers, but may be engaged on pre-sale requests as well
- Fields inbound contacts (voice/email, etc)
- Responsible for post-sales service to customers
- Logs, monitors and tracks issues to ensure accurate resolution in a timely manner
- Provides direct advice and guidance to customers in navigating Dell's website and internal policies and procedures
- Facilitates the return of equipment, missing/wrong/damaged replacements, order status and invoice and other document requests
15
Customer Care Senior Associate Resume Examples & Samples
- Provide administrative support to track, investigate and respond to Regional and Non-regional (Claims, AR etc.) Insurance Department customer complaints. Use the ARS system and State Complaint logbook to document case status
- Adhere to established complaint file administrative process requirements and ensure state responses are completed within 10 days
- Consult with sales leaders, agencies and other business units on agency/ customer policy issues
- Creates and deliver processes and procedures to enhance efficiencies
- Develop and maintain a working relationship with other business units involved with Insurance Department complaints
- Maintain and file completed Regional and Non Regional complaints
- Communicate effectively with customers and other business units, demonstrating the command of the language, grammar and composition. Capable of handling complex situations
- Facilitate change to minimize potential problems by establishing standards, procedures and benchmarks
16
Pre-certification Care Senior Associate Resume Examples & Samples
- Review authorization requests and make determinations on correct authorization process (i.e. auto approve, refer to Precert Nurse or Medical Director)
- Proficient knowledge of departmental policies and procedures; knowledge of Medicare, HIPPA and NCQA
- High School Diploma or GED required; AAS preferred
- 2+ years’ experience in a managed care environment
- Proficiency in medical terminology, CPT and ICD-9/ICD-10 coding PREFERRED
- Intermediate knowledge of Microsoft Office including SharePoint, Outlook, PowerPoint, Excel and Word
17
Care Senior Associate Resume Examples & Samples
- Bachelor’s degree in mental health field or psychology/social work related field strongly preferred (can also include: family communications, health coaching, community/public health or other related major). This is a non-clinical role and does not require a license
- Previous customer service experience or related position
- Superb interpersonal communication
- Effective listening and organizational skills
- Ability to manage multiple tasks, setting priorities where needed
- Independently problem solve, with ability to function without constant supervision
- A demonstrated ability to type effectively; with strong PC skills/word processing experience and ability to learn new computer software systems
- Ability to learn new workflows and tasks quickly
- Ability to work independently and be a team player
- Preferred qualifications
- Masters degree in mental health field or psychology/social work related field
- Previous call center environment experience
- Creative and innovative thinking
18
Care Senior Associate Resume Examples & Samples
- Must have a High School Diploma or equivalent
- Medical administrative background of at least 1 year experience in healthcare, medical management or managed care environment
- Experience with Texas Medicaid a strong plus. Medical Assistant or other health related certification preferred
- Intermediate skills in Microsoft Word, Outlook, and Excel
- Good organizational, written, and oral communication skills
- Knowledge with home modification a plus
19
Care Senior Associate Resume Examples & Samples
- Medical administrative background of at least 1 year experience in healthcare, medical management or managed care environment required
- Experience with Texas Medicaid a strong plus
- Medical Assistant or other health related certification preferred
20
Customer Care Senior Associate Resume Examples & Samples
- Servicing and supporting English speaking customers in emerging markets
- Answering properly customer requests and fix non-technical issues by providing the best solutions
- Understanding the customer needs and ensuring full ownership of all internal and external customer requests
21
Floor Care Senior Associate Resume Examples & Samples
- Minimum of 18 years of age required
- Ability to comprehend materials safety data sheets and chemical labels required
- Good written and verbal communication required
- Floor care experience in a commercial or non-commercial setting preferred
- Floor care experience in a healthcare setting preferred
- Experience with battery operated custodial equipment preferred
