Dynamic insurance professional bringing 12 years of experience in the field of health insurance with an
emphasis on International Network Management.
Education and Training
BBA:Business Administration,2012Strayer University - Newark, DE, USA
Minor in Management
MBA:Business Administration,2018Goldey Beacom College - Wilmington, DE, USACoursework in Healthcare
Strong interpersonal and communication Provider and Vendor Negotiations
Analytical International travel
Self-directed Proven patience and self-discipline
Personal and professional integrity
Relationship and team building
Proven patience and self-discipline
Relationship and team building
In-depth claims knowledge
Claims analysis and review specialist
Critical thinking proficiency
Network Manager, 04/2012 to CurrentAetna International - Hartford, CT
Created annual goals, objectives and budget and made recommendations to reduce costs.
Organized and led weekly personnel meetings with Network Vendors in various countries.
Responsible for successful management of seven Network relationships and hundreds of directly contracted providers.
Experience in the Latin America Market including Network Vendors and Provider Communities Negotiation of contract terms, rates and discounts
Responsible for maintaining vendor/provider and client satisfaction.
Fraud Specialist, 08/2009 to 04/2012Cigna International - Wilmington, DE
Performed specified investigative steps related to investigation of known or suspected fraud perpetrated against the company or customers.
Perform desk and on-site investigational audits.
Develop, perform, and present fraud cases.
Research records and obtain, analyze, and appraise evidentiary data.
Investigate fraud by obtaining statements of fact, depositions or confessions from complainants, employers and witnesses.
Oversee the development and implementation of fraud prevention, detection and resolution strategies.
Provider Contractor, CIEB, 04/2005 to 08/2009Cigna International - Claymont, DE
Managed the provider contracting network for Latin America.
Prepares, analyzes, reviews, and projects financial impact of larger or complex provider contracts and alternate contract terms.
Conducts negotiations and drafts individual contracts.
Ensures the smooth operation and administration of provider agreements.
Track financial performance of contracts and ensure compliance with contracting guidelines.
Customer Service Advocate , 06/2004 to 04/2005Cigna International - Claymont, DE
Responds to customer, health care professional and client inquiries.
Eligibility to receive benefits associated with their individual or company sponsored health insurance plan Determination of out of pocket costs related to medical or dental office visits, prescription medications, inpatient and outpatient procedures, diagnostic imaging for treatment of injuries, medical equipment and preventive care.
Understanding of payments and claims related to office and hospital visits and medical and dental procedures, and thoroughly explaining how customer benefits are applied to costs associated with these visits and procedures.
Finding an in-network primary care or specialist doctor in a geographical area or specialty.
Education on disease management programs and healthy living programs personalized to the customer's medical condition or health improvement goals.
Retail Investment Group (RIG), 09/1998 to 06/2004Wachovia Bank - Wilmington, DE
Managed operational administration of Individual Retirement Accounts. Handled IRS compliance and system integrity. Assessed receipt of Retirement Account Transaction forms.
Aided employees and customers.
Updated individual customer files.
Administered Retirement account transfer requests. Reviewed IRA distributions and conducted research.
Assistant Store Manager, 08/1990 to 12/1997Fashion Bug (Charming Shoppes Inc.) - Middletown, NY
Completes store operational requirements by scheduling and assigning employees; following up on work results.
Maintains store staff by recruiting, selecting, orienting, and training employees.
Maintains store staff job results by coaching, counseling, and disciplining employees; planning, monitoring, and appraising job results.
Achieves financial objectives by preparing an annual budget; scheduling expenditures; analyzing variances; initiating corrective actions.
Identifies current and future customer requirements by establishing rapport with potential and actual customers and other persons in a position to understand service requirements.
Ensures availability of merchandise and services by approving contracts; maintaining inventories.