government appeals supervisor resume example with 6+ years of experience

Jessica Claire
, , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
Home: (555) 432-1000 - Cell: - - : - -
Professional Summary

Performance-oriented and dedicated to maintaining agility, responsiveness and efficiency of Healthcare operations. Successful history bringing in top-notch staff, improving operational strategies and boosting team performance. Articulate and encouraging leader with decisive nature and forward-thinking approach.

  • SAP expertise
  • Project development and life cycle
  • Risk analysis and management
  • Cost reduction strategies
  • Business planning
  • Natural leader
  • Performance Evaluations
  • Operations management
  • Unsurpassed work ethic
  • Fluent in Spanish
  • Employee relations and conflict resolution
  • Project Management
Work History
12/2017 to Current
Government Appeals Supervisor Sea Mar Community Health Centers Vancouver - Delaware, WA,
  • Set, enforced and optimized internal policies to maintain efficiency and responsiveness to demands.
  • Devised, deployed and monitored processes to boost long-term business success and increase profit levels.
  • Reviewed financial reports each day and investigated variances with accounting staff to keep records accurate.
  • Collaborated with process owners to refine procedures, devise best practices and correct quality audit findings.
  • Generated comprehensive reports regarding incidents, events and important business matters.
  • Directed activities and initiatives to achieve regulatory compliance, foster good manufacturing practices and meet component quality standards.
  • Optimized organizational operations and facilitated decision-making by examining problem-solving concepts, including quantitative methods and techniques.
  • Provided excellent customer care to maintain and improve customer relations, strengthen loyalty and increase product and service sales.
  • Conducted performance reviews each quarter, offering praise and recommendations for improvement.
  • Worked in matrix management environment with oversight of division level managers, operations, sales, finance, human resources, safety and compliance.
  • Cultivated strong business relationships with clients to increase overall experience, satisfaction and retention rates.
  • Organized preventive maintenance to reduce downtime and line shutdown or production delays.
  • Established operational objectives and work plans and delegated assignments to subordinate managers.
04/2016 to 12/2017
Appels Subject Matter Expert United Healthcare City, STATE,
  • Designed and prepared technical reports, studies and related documentation.
  • Collaborated with senior management and business line management to identify and prioritize new concepts for development and launch.
  • Performed ad hoc deep-dive analyses for specific business problems.
  • Established extensive procedures and policies for troubleshooting and resolving hardware and software issues.
  • Developed business cases, presentations and reports for senior management.
  • Documented client progress through case notes and documentation.
08/2014 to 04/2016
Pharmacy Technician OptumRx City, STATE,
  • Consulted with insurance company representatives to complete claims processing, resolve concerns and reconcile payments.
  • Communicated with patients to collect information about prescriptions and medical conditions or arrange consultations with pharmacists.
  • Reviewed and verified customer information and insurance provider information.
  • Assisted pharmacist by filling prescriptions 14 customers per hour and responding to patient questions regarding prescription and medication-specific issues.
  • Calculated dosage, filled prescriptions and prepared prescription labels with absolute accuracy.
  • Counted, measured and compounded medications following standard procedures.
  • Provided consultations and answered inquiries from patients, healthcare professionals and physicians regarding drugs, potential side effects and specified use.
  • Counted and labeled prescriptions with correct item and quantity.
  • Performed various pharmacy operational activities with strong commitment to accuracy, efficiency and service quality.
  • Ordered medicines daily to replenish stock and increase inventory in anticipation of need.
  • Solved customer problems in-person or over telephone by providing assistance with placing orders, navigating systems and locating items.
  • Coordinated with insurance representatives to process claims and calculate correct co-pay information for patients.
  • Prepared bills for insurance companies.
  • Resolved non-routine issues like third-party billing, computer system and customer service issues.
  • Communicated with prescribers to verify medication dosages, refill authorizations and patient information.
  • Entered and processed patients' prescriptions into internal system.
  • Maintained proper drug storage procedures, registries, and records for controlled drugs.
  • Verified patient data and billing information to discover and resolve erroneous bills due to system errors.
  • Helped pharmacist clear problematic prescriptions and address customer questions to keep pharmacy efficient.
  • Liaised with other pharmacies to eliminate issues related to product expiration.
  • Performed wide range of pharmacy operations with strong commitment to accuracy, efficiency and service quality.
  • Assisted patients in minimizing medical expenses by recommending generic alternative prescription medications.
  • Collected co-payments or full payments from customers.
  • Answered incoming phone calls and addressed questions from customers and healthcare providers.
  • Processed incoming drug orders.
Expected in 01/2012 to to
No Degree: Pharmacy Technology
Boston Reed - Rowland Heights, CA,
Expected in 06/2008 to to
High School Diploma:
Nogales High School - La Puente, CA
Native or Bilingual

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Resume Overview

School Attended

  • Boston Reed
  • Nogales High School

Job Titles Held:

  • Government Appeals Supervisor
  • Appels Subject Matter Expert
  • Pharmacy Technician


  • No Degree
  • High School Diploma

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