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Click here or scroll down to respond to this candidateCandidate's Name
Street Address PHONE NUMBER AVAILABLE EMAIL AVAILABLESummary of QualificationsTeam LeadershipAbility to work independentlyCustomer focused and proactiveOrganizational skills and planning abilitiesPrioritization and time management skillsCritical thinking, decision making and problem solving skillsStrong communication and interpersonalskillsProfessional ExperienceCiti- Hagerstown, MD August 2019 August 2024Fraud Ops Senior SupervisorLed and developed a medium sized team of Fraud Agents and ensure they consistently meet performance metrics and provide effective customer service while making the proper risk assessments for Citis clientsManaged department projects/processes, monitors and analyzes changes in Fraud trends/call volumes, and provides evaluative judgment based on analysis of factual information in variable and unique situations. Applies in-depth disciplinary knowledge of concepts and procedures within own area to resolve issues and minimize Fraud LossDirectly impacted their area through shared responsibility for delivery of end results and contribution to planning and formulation of procedures; influenced resource planning. Persuaded and influenced others through strong communication and diplomacy skillsDeveloped leaders and their skill set and provide growth opportunities through guidance and mentorship in conjunction with succession planningEvaluated teams performance and made recommendations for staffing, pay increases, promotions, terminations, staffing, etc.Created and executed realistic action steps and timelines for the team with a strict attention to details and performanceDrove organizational change through innovation and process improvement, eliminating friction points for teamAchieved team performance excellence to ensure high quality and high-volume productivityRecruited, hired and built a team of highly productive candidates through coaching, collaboration, and motivation of staffFulfilled the clients necessities while providing an exceptional client experience which was measured by specific metricsAppropriately assessed risk when business decisions were made, demonstrating particular consideration for the firm's reputation and safeguarding Citigroup, its clients and assets, by driving compliance with applicable laws, rules and regulations, adhering to Policy, applying sound ethical judgment regarding personal behavior, conduct and business practices, and escalating, managing and reporting control issues with transparency, as well as effectively supervising the activity of others and created accountability with those who failed to maintain these standards.Citi- Hagerstown, MD August 2016 August 2019Ops Support Assistant 2Assist Fraud Entry Warning (FEW) associates working with client accounts to ensure superior service is provided while following approved standard operation procedures.Handles escalated client calls where supervisor assistance is requested.Conducts Quality Control with clients regarding their recent interactions/experiences with Citi.Makes recommendations for process improvements to manager.Interacts with all levels of managers, internal departments, and external clients to resolve complex problems.Monitors department inventories and workflow, ensuring timely completion.Answers staff questions on a regular basis; provides direction to accomplish assigned tasks, escalating issues with direct manager.Provides side-by-side coaching for new hires and associates as requested.Attends conference calls and meetings as a subject matter expert.Continually receives positive reviews with providing excellent customer service.Received the Citi Star Player Award for outstanding performance in September.Citi- Hagerstown, MD April 2015 August 2106DOSS Fraud SpecialistCollaborated with high profile clients to help resolve credit card account issues.Managed a wide variety of clients to resolve customer issues quickly and efficiently.Investigated and resolved customer complaints and inquiries in a timely manner.Assisted the team with Average Handle Time (AHT) and After Call Work (ACW) to stay within company standards.Developed a reputation as an efficient service provider with high levels of accuracy.Assisted trainers as a Training Service Professional (TSP) in developing associates skill.Assisted my manager and other department managers with special projects.Helped instructors facilitate training to 25 or more colleagues how to use a system and process claims.Appointed to mentor new hires in customer service.Received positive reviews with providing excellent customer service.Achieved monthly individual and team based targeted performance goals.Received the Citi Star Player Award for outstanding performance in January, May, and August 2016.Received the Be Remarkable Award for outstanding performance in exemplifying the Power of One Principle Moods in 1st quarter 2016.Citi - Hagerstown, MD March 2014 April 2015Ops Fraud SpecialistExamined account transaction history to determine appropriateness of transactions.Built brand loyalty and enhanced customer experience by possessing Citi's Client Excellence Values.Made outbound and handled inbound calls daily to assist customers with credit card accounts and fraudulent activity while using and maintaining multiple computer systems.Reviewed newly booked and established accounts to assess risk level, verify recent activity, and search for fraudulent trends.Collaborated with field investigators, by providing information on closed fraudulent accounts.Reduced losses by 16% to the bank by detecting transaction fraud in its earliest stages utilizing FDR, Lexis Nexis, Rumba, Sawgrass, and Experian credit report information.Collaborated with other Risk departments to develop and oversee processes to achieve portfolio loss and expense objectives.Efficiently handled a high volume of escalated calls for personal credit card accounts.Ensured accurate and timely processing, through adherence of internal control policies and procedures.Achieved monthly individual and team based targeted performance goals.Received MVP award for outstanding contribution in exemplifying the Client Excellence Value of Be a Team Player in 1st quarter 2014.Received MVP award for outstanding contribution in exemplifying the Client Excellence Value of Embrace Growth and Learning Opportunities in 2nd quarter 2014.Lash Group/AmerisourceBergen Company - Rockville, MD January 2011 May 2013Program SupervisorProvided direct supervision over the day-to-day operations of 14 employees positioned within a team of 30 program assistants and specialists.Participated in screening resumes and interviewing applicants for open positions within TheraCom.Advised new employees about basic Human Resources issues, company policies and procedures within the programs protocol.Assisted manager with all interactions with other business teams including IT, reimbursement, and customer service.Managed time keeping records including answering time and attendance inquires for managers and answering any inquiries from Directors.Administered timely customer service to employees and customers pertaining to staffing, benefits, and employee related issues.Conducted weekly meetings with subordinates to update data/tracking reports.Provided training and mentoring to facilitate growth and development for team members.Identified and resolved administrative errors and discrepancies of completed reports and forwarded to the manager daily, weekly, monthly, or as needed.Handled escalated call issues from patients, providers, and the clients.Oversaw and performs Quality Assurance checks for phone and case audits.Ensured all program guidelines are followed and met with regards to insurance verifications, notes/data entry, follow ups and closing of cases.Met all quality, schedule adherence, and performance measurements.Used Microsoft Word, Excel, and Outlook to maintain personnel accountability and enter pertinent data into databases.TheraCom Inc. /Lash Group/AmerisourceBergen Company - Rockville, MD November 2007 December 2010Senior Program Specialist - Team LeaderParticipated in recruiting and interviewing applicants for open positions for Endo Pharmaceuticals for the Supprelin LA program within TheraCom.Advised new employees about basic Human Resources issues, company policies and procedures within the programs protocol.Created Microsoft Excel spreadsheets and ran reports on a weekly basis to provide to the manufacturer.Ensured excellent customer service was being relayed to all patients and their families.Resolved customer inquiries, explanation of benefits and plan through inbound telephone calls (approximately 30-50 calls per day); call resolution included investigating and/or reprocessing claims.Made outbound calls to the families to provide an overview of services that we offered through the program and provided them with their next steps.Communicated effectively with other departments, providers, or health plans to ensure prompt and accurate resolution of calls.Handled escalated call issues from patients, providers and the clients.As part of the corporate team, assisted field offices with human resource questions.Exceeded all quality, schedule adherence, and performance measurements.Worked with the physicians office and their nurses to ensure the patients needs were being met and provided the most accurate information regarding the product they are trying to obtain for their patients.Verified insurance coverage for the medication and CPT code. Submitted prior authorization requirements to the plan for review on behalf of the physician.Followed up with the Specialty pharmacies to make sure the product shipped to the appropriate location for delivery.Conducted phone and case audits on each employee to make sure policies and procedures were being followed within the program guidelines.TheraCom, Inc. - Rockville, MD September 2005 November 2007Reimbursement Representative IIVerified insurance coverage for a product called Dermagraft.Validated pharmacy coverage and medical eligibility using CPT codes.Thoroughly research specific patient cases by communicating with Medicare, Medicaid and private payers determining coverage for the product under the medical benefit.Reviewed documents, reports and forms for completeness and accuracy and enter pertinent information into an automated tracking system.Processed and completed a total of 300 separate case assessments on a quarterly basis.Ensured prior Authorization requirements are communicated to the providers, as well as specific written policy information.Researched Dermagraft code specific payment amounts.Ensured case management continues throughout treatment (typically eight applications) to ensure appropriate payments are being processed and received minimizing patient liability.Ensured cases are prioritized and completed in a timely manner to ensure product shipment for scheduled procedure date.Communicated effectively with other departments, providers, or health plans to ensure prompt and accurate resolution of calls.MAMSI/United HealthCare Insurance Co. - Frederick, MD June 2005 August 2005PCSU Senior Claims Research RepresentativePerformed a wide variety of provider services dealing with escalated complex claims issues.Conducted research and assembling pertinent facts on various assignments.Reviewed medical records for accuracy and completion as required by insurance companies.Processed claims documentation ensured proper CPT, ICD-9, HCPCS coding.Reported coding issues to management and followed up with insurance companies accordingly.Enhanced the productivity and effectiveness of the department by resolving issues in a timely manner to ensure the proper functioning of the unit.MAMSI - Frederick, MD November 1998 June 2005Senior Benefits AnalystVerified patient specific benefits and precisely documents specifics for various payer plans including patient coverage, cost share, and access/ provider options according to Healthcare Common Procedure Coding System.Resolved complex medical insurance claims and processed issues for network providers.Handled escalated claims questions from within the company.Responsible for special consideration of claims and claims research.Communicated effectively with other departments, providers, or health plans to ensure prompt and accurate resolution of calls.Handled company exceptions and special reversal projects submitted by various departments.Checked standard forms for accuracy and completeness.Inputted data into multiple systems efficiently and accurately.Claims Administration Corporation - Rockville, MD April 1992 May 1998Claims Representative ProcessorExamined claims submitted by physicians and hospitals.Identified key elements and processing requirements based on diagnosis, provider, pay key, medical policy, contracts, and policies and procedures.Efficiently and accurately processed over 400 medical claims per week to ensure timely payments are generated.Analyzed, coded, and entered medical claims into claims processing system.Randomly audited charts for accuracy of coding as assigned.Kept abreast of federal coding requirements and guidelines.EducationThomas Johnson High School - Frederick, MD General Studies - Graduates Diploma 1988SkillsMicrosoft Office Suite, Data Entry, Coding, Claims Processing, Medical Terminology, Insurance Verification, Benefit Administration, Faxing, Filing, and Typing (55 wpm)References on Request |
