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Yyyyyy x. yyyyyy

1201 Hillcrest Ct. #0000 xxxxxx xxxx , xxxx , xxxxx 00000 ~ 954-744-4493 ~


Career Profile


Key Contributor & Effective Leader with 25+ years of experience in supporting social services operations within fast-paced and high-stress medical and/or insurance environments. Significant experience in the social services field with an ability to manage both Medicare and Medicaid cases, researching client medical information, and leading cross-functional teams. Equipped with a keen ability to improve internal operations and increase efficiency levels. Excel in creating strong relationships with clients, co-workers, and members of the community.


Proficient in: Microsoft Office Suite, CGX System, CCP2 Benefit Grid, HCAT, CMS-AHCA


Key Competencies


Social Service Management Training & Development Team Leadership Client Advocacy

Strategy Development Compliance Law Complex Problem Solving Policy Development

Medicare/Medicaid Case Management People/Performance Management Internal Communication


Professional Experience

Humana Insurance Company, St. Petersburg, FL 2010-2015

Humana Cares Manager-Social Services

  Directed the day to day management of complex cases which required performing interviews via phone and coordinating client services logistics

  Updated client medical records electronically, developed action plans aimed at improving health, and provided guidance to individuals related to disease management & self-care

  Provided emotional support to both client s and their families as needed, acted as an advocate for clients, and connected clients with applicable community resources

  Acted as a Preceptor for approximately 60 Social Workers, consistently contacted over 125 members monthly, and performed 10 health & wellness Seminars in regards to Medicare Savings programs, Prostate Cancer, and the Affordable Care Act

  Awarded 2 Perfect Service Awards for Outstanding Service to both Associates and clients in addition to the Associate Impact Spotlight Recognition Award


WellCare Health Plan, Tampa, FL 2004-2010

Social Service Specialist, Lead Social Worker

  Supported logistics related to social service case management which centered on completing telephonic interviews to both the elderly and disabled population

  Performed detailed medical assessments and psycho-social evaluations in addition to working closely with several third-parties such as government agencies, providers, and medical facilities

  Monitored internal productivity in order to ensure appropriate goal attainment, reviewed clinical records, and provided coaching to others in regards to regulatory healthcare standards

  Facilitated seminars for associates and members of executive leadership on Social Security Administration standards, ICD 9/ CPT codes, and entitlement programs

  Awarded Social Worker s Recognition Award

Yyyyyy x. yyyyyy

1201 Hillcrest Ct. #0000 xxxxxx xxxx , xxxx , xxxxx 00000 ~ 954-744-4493 ~


Professional Experience Continued:

Human Resources Administration, New York, NY 1989-2005

Senior Social Worker

  Supported the management of social services within the organization which included providing support to approximately 3,500 elderly, disabled, and disadvantaged individuals

  Scheduled in-person interviews for individuals who are homebound or in nursing homes, performed research related to client s socio-economic status, and reported fraudulent claims

  Played a lead role in processing medical claims, monitored metrics for both state and federal auditing, and reviewed clinical records

  Received City of New York Human Resources Administration Dedication Service Awards (10 and 15 year awards)


Additional Experience Includes: Senior Patient Receptionist, Montefiore Medical Center (1983-1989)

Education & Professional Memberships


Bachelor of Social Work, Business Administration/Sociology, Name of College, Boca-Raton, FL


Certifications Include: Perfect Service Certification, Security Awareness, Compliance Certificate, HIPAA Regulations, and Quality Assurance Certificate

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