QUALITY CONTROL SPECIALIST | MEMBER EXPERIENCE COORDINATOR
Specializing in the Development and Implementation of Quality Focused Initiatives
Poised, results driven, collaborative professional with a demonstrated ability to conceptualize and operationalize quality focused initiatives. Skilled at presenting viable and all-encompassing solutions to organizational challenges. Intellectually nimble with the proven capacity to adapt to structural dynamics and ensure measurable business results.
Health Republic Insurance of New York, New York, NY 2015 – Nov. 2015
Vendor Oversight and Quality Specialist/ Member Solutions Specialist
Instituted Quality Prevention Initiative that focused on mitigating regulatory escalations.
Lead auditor of Vendor Engagement Strategy that concentrated on standardizing operational flows.
Co-lead the integration of vendor call center policies.
Spearheaded quality review and performance initiatives geared towards the enhancement of the member experience.
Track trending vendor performance indicators and define corrective actions as required.
Served as a liaison between call centers and executive management to ensure member experience and operations are succinct with quality initiatives.
Lead Investigator for critical issues ensuring resolution reached within 72 hours of initiation.
Managed Member Communication touchpoints designed to identify, isolate and resolve trending inquiries which impact the member experience.
Drove alignment between Vendor Partners and New York State of Health Exchange.
Manage social media content including responding to heightened member inquiries.
Health Pass New York, New York, NY 2013 - 2015
Audit Small Group renewal policies and enrollment documentation in accordance with HIPAA regulations.
Manage Group experience by providing comprehensive explanations on all aspects of benefit coverage and provide guidance regarding the facilitation of the renewal process
Provide organizational support by performing strategic outreach initiatives designed to heighten benefit awareness.
Responsible for developing and maintaining business relationships with group administrators and carrier contacts.
Coordinate Health and Life Benefit plans.
NYCCBF - New York Carpenters Benefit Fund, New York, NY 2013 - 2013
Retirement Associate (Temporary Assignment)
Calculate and process pension benefits for new retirees to be added to the system for payment
Process applications for Disability pension coordinating with medical evaluation organization
Verify that pension benefit applications are complete and accompanied by required documentation, if not, refer incomplete applications to the member and/or beneficiary
Process Qualified Domestic Relations Orders (QDRO’s) according to Fund guidelines
Assist with year-end tax reporting for members
Assist Member Services Department with pension and annuity inquiries
Assist with month-end closing of newly added pensioners
Church Pension Group / Pension Services, New York, NY 2009 - 2012
Pension Administrator – Subject Matter Expert
Spearheaded the creation of the department manual which formalized workflows and served to document processes and procedures.
Co-lead a collaborative effort with management across all internal business units to execute projects and key initiatives designed to streamline the member’s experience.
Investigate, determine root cause and recommend systematic resolutions for benefit issues.
Interpreted and provided comprehensive explanations of plan options on both an individual and an organizational level.
Manage and resolve escalated matters including the collaboration with internal departments to work isolate and resolve root cause to prevent future escalation reoccurrences.
Generate regular compliance and auditing reports to ensure plans are being administered in accordance with (ERISA) compliance.
Church Pension Group / Church Publishing, Inc., New York, NY 2006 - 2009
Marketing Associate/ Account Manager
Trained and supervised team of Customer Service Representatives which allowed for an increased revenue of approximately $100K in sales during peak period.
Supported marketing, branding, public relations and position efforts.
Served as a brand ambassador which included the attendance of key trade shows, conferences and Public Relations based events (i.e. Book signings, and author lectures/discussion forums) designed to promote the material and organization.
Managed full scope of marketing initiatives which included the implementation and tracking of initiatives from inception to completion, to be finalized by the generation of associated sales reports.
Served as a single point of contact for key trade accounts throughout the entire life of the associated contract.
Verizon, New York, NY 2000 - 2005
Sales and Service Representative
Served as front line organizational representative and a principal link between the company and its residential customers to ensure high level of customer service and an enhanced customer experience.
Responsible for effectively and efficiently addressing client concerns and complaints in a fast paced high volume call center.
Clearly and concisely communicated resolutions and account/ service details in response to client billing/service concerns while politely addressing client objections.
Worked to obtain all required information to effectively address the customer's need courteously and accurately.
Bachelor of Arts,Lehman College Bronx, NY
Major: Mass Communication; Minor: Multi-Cultural Journalism
Member of the Golden Key International Honor Society
Certifications and Licenses
Life, Accident and Health Insurance Producers License – The State of New York Department of Finance
Customer Relations Management Platforms, MS Excel, MS Word, MS PowerPoint, MS Outlook, PC/Mac Savvy