Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

LISA ADAMS

Sacramento,CA

Summary

Extensive experience in the Healthcare industry with reputable skill in relationship building, resourcefulness, priority management and optimization of organizational effectiveness. Highly motivated and results driven with commitment to continuous innovation. Committed to maintaining professional relationships to increase profitability and drive business results. Skilled Service Representative driven to maximize customer satisfaction. Eager to leverage 34 years of experience in a dynamic new position with long-term career potential and room for advancement. Use independent decision-making skills and sound judgment to positively impact company success. Hardworking and passionate job seeker with strong organizational skills

Professional and results-driven employee services specialist with proven experience in delivering effective support and solutions. Expertise in handling employee inquiries, resolving issues, and ensuring compliance with company policies. Strong focus on team collaboration, adaptability to changing needs, and achieving organizational goals. Known for excellent communication skills, problem-solving abilities, and reliable work ethic.

Overview

21
21
years of professional experience
1
1
Certification

Work History

Employer Service Representative

Anthem
01.2023 - Current
  • Provided operational support and expertise, as well as single point of service support for client requests, member billing, and associate training.
  • Service complex client accounts with timely and effective responses to the clients regarding claims and service-related concerns
  • Support/communicate team awareness of claims root cause issues, service-related trends, and points of member abrasion.
  • Lead external audits as the SME for business policies, procedures, and plan intent of benefit administration
  • Lead weekly/monthly meetings regarding claims and phone processes improvements for the operations department.
  • Distribution of communications and documents to the operational team on workflows issue and guidelines to assist in processing accuracy.
  • Document, communicate and distribute operational workflows promoting knowledge share, improved accuracy and compliance with plan specific intent, process and procedure

Process Expert, Sr

Anthem
06.2018 - 11.2022
  • Full-scope, operation leader with proven strengths in project management, business implementation and process improvement. Significant accomplishments, contributing to overall operational excellence include:
  • End-to-end quality Initiatives – Identifying trending and root cause of operational errors, mentoring fellow leadership in the development and documentation of process improvement, and following up on results to ensure operational excellence.
  • Facilitation and oversight of DMHC and external auditing processes
  • All-inclusive administrative support for Director, Union and Legal, to include collection and logging of documentation, coordination of meetings and review of findings.
  • Implementation of new programs for the company. Some programs, CIW, Solution Central, and Privacy Enhancements.
  • Successfully identify system issues, administrative changes, and assist in the implementation of system fixes
  • Inventory management and creation of action plans for goal pathing
  • Medallia management to review goals and implement coaching to support associates.
  • Participated in team meetings and training sessions to stay informed about product updates and changes.
  • Assist in putting together presentations that are effective and compelling.
  • Remain interconnected, building trusting relationships across the enterprise and offering support to our business partners in other operational areas including but not limited to customer service, AGD, PIE, Privacy Office, QA, Process Optimization and Communications

Employer Service Representative, Sr

Anthem
10.2004 - 06.2018
  • Provided operational support and expertise, as well as a single point of service support for client requests, member billing, and associate training.
  • Recognized by senior management for successfully identifying a non-administrable benefit design, proposing administrative changes, and assisting in the implementation of a new policy design of a high-profile client benefit package covering over 5000 members
  • Team leader for a staff of 75 claims and call center representatives; responsible for reviewing escalated client claims or service issues
  • Lead external audits as the SME for business policies, procedures, and plan intent of benefit administration
  • Earned multiple Impact Rewards from the account management team for role in mastering and leading the leadership team in year-end stop loss procedures for a high-profile client of over 80,000 members
  • SME for call handling processes and procedures; responsible for analyzing work processes and making recommendations for procedural and system changes to deliver quality service to clients
  • Process improvement coordinator responsible for resolution of workflow issues and escalated customer and client inquiries
  • Member of elite team tasked with identifying trends and errors negatively impacting customer service; also responsible for monitoring service levels to ensure performance guarantees are met
  • Analyzed proposed benefit packages to validate operational ability to administer the benefits and review for compliance with healthcare mandates
  • Provided coaching, objective feedback, and counseling to 50 customer service representatives.
  • Designed as the lead "go-to" person for new representatives and particularly challenging calls as one of the company’s primary mentors/trainers of both new and established employees; actions resulted in promotion to Employer Service Representative
  • Maintained productivity and quality standards at all times.
  • Identified and resolved discrepancies and errors in customer accounts.
  • Increased efficiency and performance by monitoring team member productivity and providing feedback.

Education

Diploma - General Studies

Half Moon Bay High School
Half Moon Bay, CA

Skills

  • Client relations
  • Customer Service / Claims Operations
  • Strong Analytical and Organizational skills
  • Client Audit Administration
  • Staff Training and Development
  • Written and Verbal Communication skills
  • Proficient with Microsoft Suite
  • Claims Operational Efficiency
  • Strong Communication Skills
  • Healthcare Regulation
  • Team Leadership
  • Employee Coaching
  • Time Management
  • HIPAA
  • Goal-oriented mindset
  • Call center experience
  • Dispute handling
  • Complaint resolution
  • Payment processing
  • Escalation management
  • Strong interpersonal skills
  • Performance improvement strategies
  • Coaching and mentoring
  • Training development
  • Benefits administration
  • Dispute resolution
  • Procedure implementation
  • Research proficiency
  • Process reviewing
  • Collaboration
  • Teamwork and collaboration
  • Problem-solving
  • Time management
  • Attention to detail
  • Problem-solving abilities
  • Reliability
  • Excellent communication
  • Organizational skills
  • Team collaboration
  • Active listening
  • Effective communication
  • Adaptability and flexibility
  • Decision-making
  • Training and mentoring
  • Microsoft office
  • Team building
  • Task prioritization
  • Self motivation
  • Interpersonal skills
  • Conflict resolution
  • Training and development
  • Complaint handling
  • Interpersonal communication
  • Complex Problem-solving
  • Strategic planning
  • Continuous improvement
  • Adaptability
  • Written communication
  • Project management
  • Professional demeanor
  • Problem-solving aptitude

Certification

Six Sigma Yellow Belt Training Rancho Cordova, CA

Timeline

Employer Service Representative

Anthem
01.2023 - Current

Process Expert, Sr

Anthem
06.2018 - 11.2022

Employer Service Representative, Sr

Anthem
10.2004 - 06.2018

Diploma - General Studies

Half Moon Bay High School

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LISA ADAMS