CAREER PROFILE

Focused, dedicated and results-oriented management, claims and operations profes

sional offering extensive background in recruitment, selection, evaluation, trai
ning and development of staff. Proven track record of success in driving product
ivity as well as exceeding corporate standards and expectations by utilizing ana
lytical, risk assessment and problem resolution skills. Demonstrate expertise in
implementing and documenting processes for maximum productivity. Possess innate
ability in maintaining established relationships with all levels of professiona
ls. Accomplished qualifications in identifying and capturing opportunities to ac
celerate expansion, increase revenues, and improve profit contributions. Seeking
a challenging career opportunity as Senior Management Professional that would e
ffectively utilize strong work ethics, management skills and outstanding organiz
ational leadership.
* Over 15 years of management experience with large groups including remote empl
oyees and call centers.
* Show expertise in claims from intake of claim through decision, including mana
ging claim appeals, negotiating overpayments and liaising activity between claim
ant, employer and claims examiners.
* Acquire wide-ranging field experience with sales offices and clients to guaran
tee proper claims processing.
* Expert in managing call center operations, facilities, department budget and v
endor relations.
* Equipped with enrollment experience in varied insurance products.
AREAS OF EXPERTISE
Staff Management Strategic Planning Presentation and Negotiation
Policy Development Performance Management Claims Administration
Solution Management Restructuring and Culture Changes Departmental Budget Ma
nagement
PROFESSIONAL EXPERIENCE
CURASCRIPT SPECIALTY PHARMACY * ORLANDO, FL
MANAGER OF INSURANCE VERIFICATION, ELIGIBILITY 2010
* Function effectively in providing support and guidance to the Core IV team.
* Work collaboratively with other leaders and teams to monitor and enhance overa
ll client and patient satisfaction.
* Ensure development and track compliance to quality and service standards.
* Evaluate operation and efficiency of IV team as well as recommend, develop and
implement process improvements.
* Facilitate team members with issues that need technical expertise and client s
pecific functionality interpretation.
* Demonstrate expertise in managing a group of Exempt Supervisors along with the
ir corresponding teams to guarantee maximum efficiency is maintained and quality
goals are attained.
* Develop short and long-term goals for the department and plan implementation t
o bring to completion for on-going success of department.
* Communicate with the director regarding employee/HR issues, state of the depar
tment and any service issues that involve key clients or legal risk issues to th
e company.
* Interpret data for staffing and improvements as necessary to manage change whi
le maintaining consistencies in employee tasks.
* Spearhead leadership meetings with direct reports to pass on information, stra
tegize projects and maintain all lines of communication open.
THE HARTFORD * LOS ANGELES, CA
REGIONAL ENROLLMENT MANAGER 2006-2009
* Function effectively in managing the daily operations of field enrollment cons
ultants that were remotely located in sales offices in Southern and Western Terr
itories.
* Ensure supervision on all aspects of enrollment staff hiring, training, coachi
ng and performance development to attain organizational goals.
* Provided assistance to staff development and set standards for exceptional cli
ent services and expectations for revenue growth.
* Assumed full responsibility in managing escalated claims level issues in coord
ination with claims and sales office staff.
* Played a vital role in liaising between consultants, contracted enrollees and
home office business partners to promote proactive and consultative standards fo
r the enrollment and ongoing claims experience of clients and internal staff.
* Actively participated in the development of proactive enrollment process.
* Effectively utilized appropriate systems such as salesforce.com to supervise r
evenue growth and premium/participation increases.
Notable Contributions:
Established constant record for increased premium and participation results, wh
ich positively brought an impact to the companyas profitability and departmental
goals.
INTEGRATED INSURANCE SERVICES * PASADENA, CA
CLIENT CARE SERVICES MANAGER 2005-2006
* Facilitated daily management of operational functions of call center and clien
t care advocate personnel in two locations.
* Coached and trained staff in managing incoming client claims calls with except
ional servicing skills.
* Effectively managed escalated calls as necessary to resolve claims issues with
carriers.
* Ensured maintenance of effective communication and focus on efficient resoluti
on of claims issues.
* Demonstrated expertise in managing the overall facility and operational manage
ment, which included vendor contracts, relations and accounts payable. (UPS, USP
S, Couriers)
* Efficiently resolved and negotiated claims issues as well as developed and adm
inistered activities and call center policies that promoted both employee engage
ment and knowledge retention.
* Evaluated and restructured the management of customer calls along with the doc
umentation and resolution process for claims calls.
* Instrumental in overseeing customer calls and providing coaching to staff.
* Assumed full responsibility for scheduling and managing call volumes and assig
nment completions.
* Facilitated enrollment activity for the entire products, which included medica
l, dental, Medicare, Medicaid and disability.
Notable Contributions:
Successfully attained 98% approval level on client care advocatesa performance
based on the Client Satisfaction Survey.
UNUMPROVIDENT CORPORATION * GLENDALE, CA
SALES SUPPORT MANAGER 2004-2005
* Performed an integral role as member of the sales team and management team wit
h full accountability for facility management and operations of sales office.
* Effectively managed the recruitment, training, mentoring, and performance mana
gement of sales support staff as well as sustained effective communication betwe
en staff, corporate office functional areas and sales representatives.
* Conceptualized and implemented field office sales strategies and processes suc
h as add-ons and renewals.
Notable Contributions:
Successfully implemented strategies and processes that resulted in attainment o
f sales goals for office.
INTAKE MANAGER (CLAIMS CENTER, STD/LTD AND CALL CENTER INTAKE) 2002-2004
* Oversaw claims processing and workload for the department, and managed escalat
ed claims issues.
* Granted training, performance management, scheduling and production requiremen
ts for claims intake staff.
* Ensured supervision of daily claims level and provided report to business part
ners.
* Administered call status on systems and maintained service standards.
* Function as liaison between claimant, provider and employer to guarantee compl
ete and accurate intake of claim information.
* Implemented system conversion into paperless claim environment.
* Acted as liaison between claims intake staff and internal business departments
.
* Efficiently resolved staff issues using human resources and/or employee relati
ons.
Notable Contributions:
Ensured maximum efficiency through analyzing and redesigning workflow processes
, which resulted in 92% improvement in productivity.
ACCOUNT MANAGER (CLAIM CENTER) 2000-2002
* Functioned as the single point of contact for policyholder issues and requests
specific to claims.
* Effectively studied and resolved policy level, administrative and procedural i
ssues pertaining to claims.
* Liaised between claimants, employers and examiners for claims issue resolution
as well as demonstrated subject matter expertise in claims processing to assist
sales force and national accounts teams.
* Assisted in the implementation of new accounts; provided client presentations
regarding the claims process; and instigated system demonstrations for on-site v
isits or during finalist presentations.
* Ensured exceptional management on tours and broker events and customer educati
onal seminars to uphold relationship development and added value to clients.
* Worked collaboratively with claims intake staff to guarantee flawless claims i
ntake process.
Notable Contributions:
Attained 100% closing record on the finalist presentations to gain new business
.
OTHER EXPERIENCE
* Acquired 10 years of progressive banking experience ending with a Corporate Se
rvices Officer position.
* Gained five years of experience working with computer hardware and software in
providing assistance to the medical and financial industry.
EDUCATION
Master of Arts in Leadership and Organizational Studies
Azusa Pacific University, Azusa, CA * Dec 2009
Bachelor of Science in Business Management
University of Redlands, Redlands, CA * 1993
LICENSES AND CERTIFICATIONS
Group Benefits Disability Specialist
Associate Customer Service
Life Agent Resident, FL | Life Agent Non-Resident, 13 States
Notary Public, FL