Marquis Love
Lithonia
Summary
Results-oriented professional with a proven track record of delivering impactful solutions in project management, process improvement, and Six Sigma methodologies. Recently achieved Six Sigma Green Belt certification, complementing a solid healthcare background. Dedicated to fostering collaborative partnerships, leading cross-functional teams, and exceeding client expectations. Seeking a challenging role in claims quality assurance, process optimization, and leadership in a managed care environment.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Employer and Broker Spec Analyst III Lead
Kaiser Permanente
12.2019 - Current
- Complex Issue Resolution: Address intricate and sensitive issues with innovative solutions and independent judgment. Negotiate practical and defensible resolutions for purchaser concerns.
- Retention and Growth: Identify growth and benefit expansion strategies to align with purchaser healthcare needs. Monitor and report trends to inform strategic account engagement and renewal planning.
- Process Enhancement & Data Analysis: Recognize, analyze, and report emerging trends for actionable insights. Collaborate with internal stakeholders to meet external consumer needs. Advise on process refinement opportunities.
- Continuous Learning: Complete mandatory health plan product and procedure training. Pursue ongoing skill development opportunities.
- Project Leadership: Serve as a subject matter expert for customer experience enhancement projects. Lead root cause analysis and service recovery efforts.
- Claims Management Leadership: Lead a high-performance team of claims professionals. Create reports on claims quality and identify improvement opportunities.
- Efficiency & Innovation: Leverage technology and analytics for process optimization.
- Compliance & Client Satisfaction: Maintain compliance with regulatory and contractual SLAs while exceeding client expectations.
- Contract Analysis Expertise: Review and analyze contracts with technical expertise in commercial health claims. Implement and maintain best practices for claims handling.
- Continuous Improvement: Monitor and analyze claims data to identify trends and improvements. Build strong client relationships through consistent communication and portfolio updates. Provide exceptional customer service, addressing concerns promptly and professionally.
Customer Service and Op SIR
Kaiser Permanente
06.2016 - 12.2019
- Process Improvement in Call Center Operations: Jointly accountable for overall Call Center operations, identifying and implementing process improvements. Analyzed customer data and metrics to uncover opportunities for operational enhancement.
- Personalized Training and Coaching: Delivered one-on-one training and coaching to Customer Service Representatives, enhancing their performance. Employed effective monitoring and tracking systems to ensure continuous improvement.
- Claims Compliance Audits: Conducted audits and reviews of claims to ensure compliance with industry regulations and standards. Implemented data-driven quality assurance processes to maintain high standards.
- Client Relationship Management: Maintained strong relationships with clients' audit teams, providing exceptional support during audits. Ensured client satisfaction through proactive communication and problem-solving.
- Risk Management and Fraud Detection: Identified and analyzed potential risks and fraud within the claims process, mitigating threats effectively.
- Industry Knowledge and Compliance: Stayed current on industry trends, regulations, and best practices to ensure compliance and operational excellence. Provided exceptional customer support, leading to increased loyalty and repeat business.
- Escalated Complaint Handling: Handled escalated customer complaints professionally, achieving mutually agreeable resolutions while preserving the company's reputation.
Customer service manager
Wheaton fransiscan Healthcare
05.2011 - 08.2016
- Performance Management and Personnel Oversight: Oversaw performance management of Customer Service Representatives, ensuring high standards and continuous improvement.
- Strategic Staffing Management: Managed staffing processes including conducting interviews, creating schedules, and providing coaching and training to team members.
- Billing and Communication Expertise: Specialized in communication, assisting patients with billing inquiries and handling supervisory calls effectively.
- Complaint Resolution and EPIC Expertise: Skillfully resolved complaints and grievances from members, maintaining customer satisfaction and loyalty. Served as the EPIC Subject Matter Expert (SME) during software implementation, providing guidance and support to colleagues.
- Key Role in Software Implementation: Played a crucial role as the EPIC SME during the company's software implementation, ensuring a smooth transition and effective use of the new system.
- Customer Issue Resolution: Took ownership of customer issues, following problems through to resolution, and ensuring a high level of customer satisfaction.
Education
MBA - Health Administration
Colorado Technical University
05.2024
Bachelor of Science - Health Administration
Colorado Technical University
10.2022
Skills
- Problem-Solving Service
- Data Analysis
- Data Management
- Insurance Expertise
- Leadership and Management
- Proficiency in Microsoft Excel and Word
Certification
- Certified Lean Healthcare Professional (CLHP), Six Sigma Global Institute, 08/2023
- Lean Six Sigma Green Belt Healthcare Professional, SSGI, 08/2023
- PMP Exam Preparation Training, Certificate of Completion, 08/2023
Timeline
Employer and Broker Spec Analyst III Lead
Kaiser Permanente
12.2019 - Current
Customer Service and Op SIR
Kaiser Permanente
06.2016 - 12.2019
Customer service manager
Wheaton fransiscan Healthcare
05.2011 - 08.2016
MBA - Health Administration
Colorado Technical University
Bachelor of Science - Health Administration
Colorado Technical University
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