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Click here or scroll down to respond to this candidateCandidate's Name
Professional ExperienceUnited Healthcare 2014- CurrentCall Center Supervisor Dental/Vision (San Antonio, TX)Developed and managed projects involving 1:1 Readiness planning and reporting, Specific State Medicaid peer to peer monitor/reporting, State of Kansas Medicaid Quality audits/performance reporting.Developed and managed Specialty Benefits Pulse Watch to ensure efficiency and effectiveness in-line with departmental 1:1 readiness.Coordinates, supervises and is accountable for the daily/weekly/monthly activities of team members.Sets priorities for the team to ensure task completion and performance goals are met as well as provides coaching and feedback to team members, including formal corrective action when necessaryCoordinates work activities with other supervisors, managers, and departments.Identifies and resolves operational problems using defined processes, expertise, and judgmentConducts annual performance reviews for team membersProvides expertise and customer service support to members, customers, and/or providersStrong proficiency for performing multiple software functionsUnited Healthcare Dental/Vision San Antonio, TX 2011-2014Service Account Manager AssociateManaged Southeast region of the United States which included Florida, North Carolina, South Carolina, Georgia, Alabama, Mississippi, Arkansas, Louisiana and Texas by handling all aspects of Dental and Vision claims matters from Group administration, claims processing, Member and provider appeals and grievancesPlanned and created development processes as well as provider utilization assessmentsDeveloped and maintain Microsoft access database of all incoming member, provider concerns, complaints, and supervisor coaching opportunities for the onshore and offshore sitesOrganize/maintain and processing of Dental escheatment along with over-rides and check reissues.United Healthcare Dental/Vision San Antonio, TX 2007-2011Senior Customer Service Claim Processor/ Eligibility Call Back Lead/ SST Unit assistant/ Training Unit assistant/ Certified MentorProvide benefits and eligibility for members and providersAnswer inquiries regarding member claims, process, procedures, and benefit coverageResolve concerns regarding dental claims, payments, and procedure code to include CDT codes.Knowledge of Dental health insurance terminology.Strong background in high volume call center environment.Served as a Team Leader.Coordinated and lead the Eligibility Call Back Team in responding to member, provider, and broker eligibility concernsMcFarlin Plumbing LLC San Antonio, TX 2007-2011OwnerManaged and supervised all aspects of a small business with over 15+ employees and contractors to include administration of employee files, payroll, and enforced company policies and procedures.Over 5 years of business management experience.PacifiCare (United Healthcare) San Antonio, TX 2004-2006Medical Customer Service RepresentativeProvided benefits, eligibility, and authorization for members and providers for Medical / Vision / Dental Plans.Resolved issues regarding medical claims, payments, and procedure code to include CPT and ICD9 codes.Answered inquiries regarding member eligibility, claim processing procedures and benefit coverage.Examined medical, dental, and vision claims for errors and referred for claims reconsideration.Knowledge of health insurance terminology, CPT, ICD9, ADA.Familiar with provider contractual agreements PPOs, POSs, and EPOs.Knowledge of HIPAA (Health Insurance Portability and Accountability Act of 1996).RMH Teleservices (Client UPS) San Antonio, TX 2001-2004Mentor & Learning Lab Trainer/ UPS International Customer Service Representative / UPS Universal Tracking AgentManaged/lead in the training of new employees in the learning lab (training room) prior to their transition to the main call center floor.Assisted Management in the Mentoring and Training Program for both International and Domestic AgentsPerform periodic remote call monitoring and testing of agents on the companys quality expectations and coached employees on the proper problem resolution processes and company procedures.Provided internal audit reports and many other responsibilities that would allow smooth operation of the department.Handled escalation issues when supervising.Resolved problem issues for customers who received damaged packages, were unsatisfied with services, and had documentation issues, to include NAFTA Certificate of Origin, Shippers Export Declaration, Letter of instruction, and Power of Attorneys, as well as any other shipping set back that would arise.Assist customers with inquiries on international shipments.Respond to customers request for a supervisor when necessaryAssisted inbound customer inquiries on tracking packages to and from the origin and destination location.Process and file guaranteed service refunds and damaged inspection claim reports on behalf of the shipper.Scheduled package shipments and calculated hundredweight rates on multi packages to multi-destinations.Processed delivery change request for customer to allow for proper and timely delivery.Benefit Planners LTD Boerne, TX 1998-2001Medical Claims Analyst/Customer Service RepresentativeSolved problems regarding medical claims, medical payments, and procedure code to include CPT codes and ICD9 codes.Strong background in high production environments.Answer inquiries regarding member eligibility, claims processing procedures and benefit coverage.Examined medical, dental, and vision claims for errors and referred for claims reconsideration.Heart & Vascular Institute of Texas San Antonio, TX 1993-1998Eligibility Coordinator/ Medical Records Supervisor/ ClerkDirected team members in the verification of benefit coverage information of patients to insure accurate and timely claims processingResolved issues that would arise in claims process.Assisted the billing department in claims filing and claims appeals processPreformed required audits on patients account to insure proper information retentionSupervised seven records clerks in maintaining medical files on patients.Resolved issues with obtaining medical information release.Corresponded with outside providers of service to provide medical information on patients according to proper companys guidelines.Organized and implemented guidelines to distribute/maintain accurate information to physicians and other providers of service.EducationTheodore Roosevelt High School High School Diploma Completed 1983Training SeminarsSkill Path Management TrainingRecords and Filing System ManagementPetty Officer Leadership TrainingPower Plant and Related Systems Specialist TrainingSmall Business Development Association CoursesInfluencing without Authority |
