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Click here or scroll down to respond to this candidateCandidate's Name
PHONE NUMBER AVAILABLE EMAIL AVAILABLE Milwaukee, WI Street Address Linked In: Candidate's Name
PROFESSIONAL SUMMARYExperienced HMO Advocate/Member Rights Specialist with a strong background in navigating complex healthcare systems with a proven track record of effectively representing patient interests. Im seeking to contribute to an organization that places high importance on human services, servant leadership and most importantly member efforts.SKILLS AND SOFTWARE PROFICIENCIESExperienced HMO Advocate/Member Rights Specialist * Analytical * Interpersonal Skills * Communication * Conflict Resolution * Adaptive * Ethical * Collaborative * Creative *Insightful * Strategic Team-Oriented *Critical Thinker * Relationship Management * Training and Development * Leadership and Team Management * Emotional Intelligence * Crisis Intervention * Cultural Competency * Client Correspondence Management * Escalation Resolution * Empathy * Organizational Skills * Patience * Research SkillsWORK EXPERIENCEApril 2023 Current MAXIMUS INC Milwaukee, WICounselor Case ManagerEnsure seamless access to program services for customers, acting as a pivotal point of contact.Cultivates robust customer relationships, leading to a 20% increase in program engagement and retention.Navigates customers through the application process with expertise, resulting in improvement in benefit acquisition, while ensuring access to vital support services.Executes comprehensive follow-up strategies that address customer needs, achieving a customer satisfaction rate of over 90%, and collaborates with cross-functional teams to enhance service delivery.Maintains meticulous documentation of customer interactions, contributing to a 25% increase in team efficiency and ensuring cohesive outreach strategies.Proactively identifies and resolves customer engagement barriers, streamlining processes for quicker resolution and demonstrating adaptability by taking on diverse roles as needed.September 2019 July 2020 THE JACOBSON GROUP Milwaukee, WICustomer Service Claims ManagerDelivered top-tier insurance talent on a temporary and temp-to-hire basis, adeptly managing workforce dynamics and ensuring operational resilience during workload fluctuations.Strategically addressed diverse staffing requirements ranging from backlogs, growth phases, leaves, events, attrition, or special projects, guaranteeing uninterrupted business operations and service delivery.January 2018 March 2018 iCARE INDEPENDENT HEALTH CARE PLAN Milwaukee, WIMember Advocate/ Rights SpecialistAdvocated for enrollee rights and benefits under the Wisconsin Department of Health contract, ensuring compliance with Badger Care Plus and Medicaid SSI requirements.Represented iCare in the community, upholding enrollee interests and facilitating Medicaid benefit provision.Collaborated with enrollees and providers to optimize care delivery and safeguard enrollee rights.Recommended management improvements for enhanced care quality and service delivery methods.May 2014 December 2017 MOLINA HEALTHCARE Milwaukee, WIHMO Member AdvocateAdvocated for Molina HealthCare and enrollee interests, ensuring adherence to Wisconsin Department of Health contracts for BadgerCare Plus and Medicaid SSI.Facilitated collaboration between members and providers to secure benefits and protect member rights within the BadgerCare Plus framework.Provided guidance and advocacy for individuals with disabilities or on BadgerCare Plus, serving as a liaison for member advocacy groups and community organizations.Analyzed and recommended enhancements to HMO internal systems, aiming to improve member access to medical care and the quality of care provided.Served as a resource for Molina HealthCare staff and members, offering information on community services, resources, and special needs referrals.Conducted ongoing training for HMO staff and providers, focusing on cultural sensitivity and healthcare practices, while also addressing member access barriers and policy alignment.January 2008 April 2014 CHILDRENS COMMUNITY HEALTH PLAN Milwaukee, WIHMO Member AdvocateFacilitated timely access to BadgerCare Plus benefits for CCHP members, contributing to a smoother and more efficient healthcare experience.Ensured CCHP members received all medically necessary services, playing a crucial role in the maintenance of their health and well-being.Recommended improvements to CCHP management, leading to enhanced member access and care quality, demonstrating a proactive approach to healthcare advocacy.Reviewed and suggested modifications to systems/processes impacting care delivery, showcasing analytical skills and a commitment to operational excellence.Complied with Wisconsin Department of Health contract requirements for BadgerCare Plus and/or Medicaid SSI, ensuring adherence to regulatory standards.EDUCATIONSeptember 1985 June 1989 Custer High School |
