Desiree D. Hopkins
Baltimore
Summary
Highly accomplished Insurance Services Manager and Senior Claims Technician with over 25 years of comprehensive experience in insurance operations, customer service, and team leadership. Adept at managing complex claims, ensuring policy compliance, and improving operational efficiency through strategic problem-solving and training. Recognized for exceptional interpersonal skills, fraud identification capabilities, and a commitment to delivering superior client and provider support. Proven success in cross-functional collaboration, quality control, and productivity enhancement across fast-paced, high-volume environments.
Overview
47
47
years of professional experience
Work History
Account Service Representative II
CareFirst BlueCross BlueShield
01.2008 - Current
- Serve as primary liaison for group and provider inquiries, ensuring prompt and accurate issue resolution
- Conduct in-depth research for high-level inquiries from Executive Inquiry and Maryland Insurance Administration (MIA)
- Prepare and deliver detailed reports to management, tracking key performance metrics and service outcomes
- Attend and contribute to Implementation and Group Renewal meetings, ensuring smooth onboarding and renewal processes
- Collaborate cross-functionally with internal departments to streamline service operations and resolve escalated concerns
- Consistently exceed departmental production and quality benchmarks
- Recognized for excellent customer service and problem-solving under pressure
Provider/Member Service Representative III
CareFirst BlueCross BlueShield
01.1994 - 01.2008
- Delivered concierge-level service for members and providers, resolving complex issues in a timely and empathetic manner
- Provided expert policy and benefit interpretation for walk-in clients in the Lobby Service area
- Managed supervisor-level escalations, ensuring thorough resolution and customer satisfaction
- Maintained high standards for accuracy and productivity within a fast-paced service environment
- Awarded for outstanding service delivery and accuracy in claims and member resolution
- Played a pivotal role in department training initiatives to improve staff capabilities
Claims/Customer Service Supervisor | Quality Verification Auditor | Trainer
Claims Administration Corporation
01.1982 - 01.1994
- Oversaw critical managerial functions in claims processing, customer service, and quality control
- Developed and led comprehensive training programs for staff, improving performance and efficiency
- Monitored productivity and implemented process improvements to enhance service delivery
- Identified and reported fraudulent claims, mitigating financial risk
- Acted as a key liaison with providers, claimants, underwriters, and medical review personnel
- Traveled nationwide to lead large-scale presentations and manage marketing initiatives
- Implemented fraud prevention measures that resulted in significant cost savings
- Led successful nationwide training and marketing initiatives to increase brand awareness
Senior Auditor / Claims Examiner
Mutual of Omaha
01.1978 - 01.1982
- Performed audits and examined insurance claims for accuracy and compliance with company policies
- Ensured timely and accurate claims resolution while upholding company standards
Education
Completed Courses - Business Administration
University of Maryland
College Park, MDSkills
- Insurance Operations & Policy Interpretation
- Customer & Provider Relations
- Quality Assurance & Compliance
- Fraud Detection & Risk Mitigation
- Personnel Training & Leadership
- Process Improvement & Efficiency
- Claims Management & Resolution
- Executive & Regulatory Inquiry Handling
Training
- Medical Terminology
- Interpersonal Problem Solving I & II
- Management Development I & II
- Candidate Selection and Interviewing
Timeline
Account Service Representative II
CareFirst BlueCross BlueShield
01.2008 - Current
Provider/Member Service Representative III
CareFirst BlueCross BlueShield
01.1994 - 01.2008
Claims/Customer Service Supervisor | Quality Verification Auditor | Trainer
Claims Administration Corporation
01.1982 - 01.1994
Senior Auditor / Claims Examiner
Mutual of Omaha
01.1978 - 01.1982
Completed Courses - Business Administration
University of Maryland
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