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licensing coordinator resume example with 9+ years of experience

Jessica Claire
, , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
Home: (555) 432-1000 - Cell: - resumesample@example.com - -
Professional Summary
Case Manager with a combined 14.5 years of experience in social work and case management. Proficient in client and social services; psychological/behavioral management; client/family engagement strategies and care plan implementation. Over 20 years of customer service experience. Currently working in licensing and compliance. Indianapolis, IN EXPERTISE Modern methods of Case Management in Social, Medical, Behavioral, and Addiction Root Cause Analysis Treatment Case Management Personal Development Human Relations
Skills
  • PERSONAL
  • SKILLS
  • Productivity
  • Proactive
  • Initiative
  • Intelligence
  • Intuitive
  • Sociability
  • Empathy
  • Courage
  • Considerate
  • Behavioral Health
  • Problem Resolution
  • Follow-Up
  • Customer Service
Work History
09/2021 to Current
Licensing Coordinator Arthur J Gallagher & Co. Sherwood, AR,
  • Review, evaluate, and approve/deny contracting applications.
  • Investigate credit, criminal, and financial reports for fraud detection.
  • Conduct monthly licensing and education audits.
  • Build agent contracts in licensing systems.
  • Update agent profile changes in various licensing systems
  • Network, Build, and Maintain relationships with licensing agents and insurance corporations
  • Communicate and respond to business partner prospects to determine if licensing agent applicant is eligible to partner with Insurance Group(s)
  • Terminate agent contracts
  • Consistent task management exceeding 98th percentile over a 4-week rolling average.
  • Daily administrative routines - Data entry, Reporting, File Management
  • Current with continuous 48, AK & HI state laws and licensing requirements to ensure an accurate and efficient review process.
  • Engagement - Weekly interactive team ideation and engagement meetings
  • Customer facing communication and professional writings
10/2019 to 06/2021
Lead Re-Employment Coordinator WorkOne Indy City, STATE,
  • Matched clients to open positions based on skills and work requirements.
  • Build events in Case Management Systems.
  • Generate and mail response communication to customers.
  • Schedule, coordinate and lead (group or individual) reemployment programs; i.e., orientations, assessments and workshops.
  • Conduct weekly customer profile process reviews to determine transfers, eligibility and execute as appropriate.
  • Appointment scheduling
  • Resume Reviews and Interview preparation with customers
  • Search and send job recommendations to customers.
  • Recruit customers to attend weekly Job fairs and onsite job interviews.
  • Comprehensive interview and assessment process to develop an Individual Reemployment Plan (IRP).
  • Review, promote and refer all qualifying customers to program match(es).
  • Review Labor Market Information (LMI) and TORQ results with customers.
  • Record all pertinent data related to all RES programs in the Case Management System.
  • Maintain all excel spreadsheets and/or other documents.
  • Submit the Failed to Participate (FTP) and Re-qualification documentation to Department of Workforce Development.
  • Correct any service entry or reporting errors
  • Refer customers to appropriate partner programs for additional services when deemed necessary.
  • Conduct follow up and 45 day program completion audit review.
  • Audit team performance and prepare evaluations.
  • Train and mentor new staff.
  • Demonstrated sound time management and project management skills by effectively and efficiently organizing, prioritizing and completing multiple assignments in a timely manner.
  • Proficient with Microsoft Suite tools and Internet Navigation skills.
  • Matched clients to open positions based on skills and work requirements
  • Planned and launched large-scale events that boosted employee participation.
  • Coordinated implementation of people-related services, policies and programs through departmental staff
  • Improved office efficiency by effectively managing internal communications and correspondence
  • Planned, monitored and appraised employee work results by training managers to coach and discipline employees
  • Improved organizational filing systems for confidential employee records, resulting in improved accessibility and efficiency
  • Sharepoint
  • Peoplesoft
10/2012 to 05/2019
Medical Management Specialist III Anthem City, STATE,
  • Gathers clinical information regarding case and determines appropriate area to refer or assign case (utilization management, case management, QI, Med Review).
  • Monitor RCP program for the state of Indiana.


Audit weekly and monthly member activity.


  • Review members claims to determine if they are abusing and overusing health benefits.

  • Investigate if members are involved in fraud and drug abuse.

  • Restrict members access to certain health services provided by state insurance.

Authorize members and doctors request for health and referral services.
Report member to FSSA for violation of services.


  • Provide members with counseling and education and intervention options.
    Prepare weekly reports for daily compliance meetings.

  • Research fraud and abuse claims and report to the state.
  • Conducts initial review of files to determine appropriate action required. Maintains and updates tracking databases.
  • Responds to requests, calls or correspondence within scope.
  • Acts as liaison between medical management operations and other internal departments to support ease of administration of medical benefits. May assist with case referral process.
  • May collaborate with external community-based organizations to facilitate and coordinate care under the direction of an RN Case Manager.
  • Educate members on use of ER and doctor office visits.
  • Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical information.
  • Handle member calls for Value Added Benefits.
  • Prepare weekly spreadsheets, track, and load to SharePoint.
  • Perform doctor searches for members and case managers.
  • Community Health Worker certified
  • Complete members' authorizations for medical services.
  • Assist members with community resources.
  • Connect members to Case Managers and Community Health Workers in their area to assist with health needs.
  • Assist Medicaid and HIP members.
  • Process authorizations for members procedures.
  • Medical coding

Education
Expected in 05/2016
Master of Science: Psychology
Martin University - Indianapolis, IN
GPA:
Expected in 05/2002
Bachelor of Science: Social Work
IUPUI - Indiana,
GPA:
Expected in 05/1996
Associate of Science: Cosmetology
Mackenzie Career Center - Indianapolis,
GPA:
Additional Information
  • Indianapolis, IN

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Resume Overview

School Attended

  • Martin University
  • IUPUI
  • Mackenzie Career Center

Job Titles Held:

  • Licensing Coordinator
  • Lead Re-Employment Coordinator
  • Medical Management Specialist III

Degrees

  • Master of Science
  • Bachelor of Science
  • Associate of Science

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