1. Taynia Rice
24 Naden Ave
Irvington, NJ 07111
Telephone Number: 973-820-7022
Objective: To obtain a responsible position offering professional growth that will utilize my skills, expand
my knowledge, career advancement and afford me an immediate challenge.
Qualifications
Strong analytical and detail orientated skills.
Excellent Organizational and verbal communication skills.
Demonstrated ability to acquire and apply knowledge rapidly.
Proficient in providing world class service and attaining set goals.
Education
1990-1994 Diploma, Clifford J Scott High School
Horizon-BCBSNJ Employment
August 2011 Supervisor II- Current, Quality Measurement
Responsibilities include managing a staff of 18, monitor annual budget for salary cap, available
open job requisites, and budgeting overtime cost. Conduct monthly One on Ones with the Audit
staff to ensure individual goals and Core Competencies are met as required. Complete Mid-year /
Year-end performance appraisals and determine AIP amounts and Merit increases based on the
employee performance goals. Work directly with Vendor Business Partners to coordinate
monthly quality reviews and the onboarding process for new business. Assist in developing
process workflows for various teams. Organize monthly Calibration meetings with internal
Business Teams and Vendor Business Partners to review trending and gap analysis. Analyze data
analysis and provide recommendations for process improvement.
October 2007 Sr. Quality Auditor II, Quality Measurement
Responsible for auditing telephone calls, correspondence and billing and enrollment applications.
Monitor daily production, provide coaching and Quality on Quality review to the junior staff.
Monthly One on One’s are held to ensure the auditors are staying on track and meeting the
expectations as outlined in their job description.
May 2005 Quality Auditor I, Quality Measurement
Responsible for completing a monthly quality sample on CSR's, consisting of telephone calls and
correspondence. Quality is performed to ensure accurate information is being provided and to
have any necessary corrections made to any claims or written responses done incorrectly.
October 2003 Resolution Analyst, Provider Services
Coaching, providing resolution on provider complaints, accounts receivables and claim edits.
Assuring providers contract effective and termination status are updated along with current fee
schedules.
April 2002 Member Services Coordinator, Plan Employee Team

2. Resolving Member and Provider inquiries via telephone or correspondence. Process claims,
correspondence, benefits and resolving enrollment issues. Responsibilities also include handling
Mac Bic appeals, DOBI cases and Executive inquiries with specific case resolution.
April 1999 Client Service Consultant, State Health Benefits Program
Responsible for resolving telephone and written inquiries for subscribers and providers, claims
processing, benefit enrollment inquiries, notifications to the local BCBS Plans and resolving
complaints for the Division of Pensions and Benefits.
Prior Employment
1998-1999 Sales Representative, United Window & Door
Window sales and product advertisement to local vendors. Price quotes, delivery scheduling and
assisting with any technical questions regarding company products.
1996-1998 Customer Service Representative, Prudential Health Care
Responsible for telephone and claims processing, benefits and eligibility questions regarding
managed care products for Senior Care POS and HMO.
PC Skills
Proficient in Microsoft Office, Lotus Notes, UCSW, Qblue, Outlook, CPW, NMS, Nasco,
Integrated Talent Management (ITM).
Certifications
Supervisor Development (SDP) and Manager Development Program (MDP)