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0000 xxxxxx xxxx , xxxx , xxxxx 00000 xxx-xxx-xxxx abc@xyz.com

Customer Service Excellence Process Optimization Team Leadership

Training & Coaching Customer Needs Assessments Policy Compliance

         Substantial talents in business process analysis, claim research, client support, problem solving, and rectifying provider issues to maintain peak levels of satisfaction and retention.

         Consummate experience with medical insurance policies encompassing HMOs, PPOs, Coordination of Benefits, Pharmacy, Medicaid, and Medicare.

         Considerable training, mentoring, and team leadership expertise; highly respected resource to peers.

         Able to analyze provider performance and establish cost-effective provider reimbursement arrangements.

         Well-versed in all facets of provider relations; able to initiate strategies and programs to enhance relationships between health plan, providers, and practice managers.

         Solid reputation for integrity, collaborative work ethic, listening skills, and respect for diversity.

         Possess an excellent understanding of policies and procedures that impact providers, with an emphasis on reimbursement, claims, and appeals.

         Advanced understanding of internal claims and payment policies and procedures.

         Leverage persuasive communication skills to advocate and communicate provider tools and resources.

         Join forces with internal groups to identify, interpret, and improve available resources, systems, and capabilities that can bolster provider, member, and company performance.

UnitedHealth Group 1999 to Present

Combined Accumulator Reconciliation Team 2012 Present

         Support Error Report Team by conducting research to uncover root cause for business process fails.

         Collaborate extensively with Service Account Manager, Client Manager, and Benefit Analyst to swiftly correct benefit eligibility issues, critical to achieving and maintaining quality assurance goals and standards.

         Methodically assess out-of-pocket accumulators for members to validate accuracy of fiscal obligations.

         Enforce risk management policies and protocols by steering constant compliance with HIPAA guidelines.

Claim Analyst 2001 2012

         Systematically scrutinized claims which were closed or denied to ensure accuracy and applied adjustments accordingly for submission to correct payment to providers.

         Referred to member benefit terms and provider contractual agreements to verify correctness of payments.

         Applied dynamic leadership talents toward coaching, mentoring, and training peers while serving as team subject matter expert (SME) and influential resource.

Customer Service Representative 1999 2001

         Delivered outstanding customer service to members and providers by responding to a wide range of benefit and claim issues; consistently surpassed assigned production goals and quality targets.

Associates of Arts, Concentration in Business, anticipated completion March 2018

University of Phoenix, Phoenix, AZ