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Senior Disability Claim Manager Resume Example

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Jessica
Claire
resumesample@example.com
(555) 432-1000,
Montgomery Street, San Francisco, CA 94105
:
Summary

Proficient leader with 20 plus years experience in different aspects of the healthcare industry including  leadership roles from 6 years as a Lead Pharmacy Technician to 3 years as Lead Patient Care Coordinator. Through these roles I have developed work flow processes, training programs, performed audits and networked with national leadership to improve processes. I have strong leadership and relationship building skills. 

Skills
  • Operations management
  • Staff development
  • Inventory control
  • Complex problem solving
  • Staff training
  • Supervision and training
  • Computer-savvy
  • Calm under pressure
  • Time management skills 
Education and Training
Grand Canyon University Phoenix, AZ Expected in 2018 Masters of Business Administration and Management : Health Systems Management - GPA :

Health Systems Management

Murray State University Murray, KY Expected in 2014 Bachelors of Science : Business - GPA : Business
Madisonville Community College Madisonville, KY Expected in 2011 Associates of Arts : Business Business Administration - GPA : Business Both Degrees major in Business Administration and Management
Experience
Uc Health - Senior Disability Claim Manager
Gillette, WY, 11/2015 - Current
  • Work directly with clients and Vocational Rehabilitation Counselors to facilitate return to work either on a full-time or modified duty basis.
  • Network with both customers and physicians to medically manage claims from initial medical requests to reviewing and evaluating ongoing medical information.
  • Pay all covered claims accurately and timely through SRO and WorkBench.
  • Execute on all customer performance guarantees.
  • Respond to all telephonic and email inquiries within customer service protocols in a clear, concise and timely manner.
  • Handle potentially high levels of call volume from customers and clients.
  • Claim management performance according to quality and compliance standards.
  • Manage both new claims and open claims equally and maintains decision times.
  • Comply to standard timeframes for processing mail, tasks and outliers.
  • Support and promote all integration initiatives (including Family Medical Leave, Life Assistance Programs, Integrated Personal Health Team, Your Health First, Healthcare Connect, etc.) Received Cigna Champion Award for customer service Received Cigna Group Operations Return-to-Work Partner Award 2nd Quarter Trained and implement new program, Work Bench, to work from home, as well as work on old program, Acclaim.
  • Conducted analysis to address eligibility which led to approving or denying claims.
St. Joseph Health - Associate Business Analyst/Lead Patient Care Coord
Irvine, CA, 02/2015 - 10/2017
  • Analyzed and process data for finance and sales team Developed workflows and processes utilizing Adobe Acrobat Pro Reconciled invoices utilizing Microsoft Excel, Access and Pivot Tables Utilized AHCCCS and MVP files to support analysis 
  • Developed and implement effective solutions to findings from reconciliations 
  • Acted as site lead for Integrity Data for Mass Comparison Report for Arizona and California utilizing data analyzation and Excel 
  • Planned and executed meetings to review Mass Comparison Report 
  • Assigned employees tasks to complete prior to meetings
  •  Ran SQL reports and exported them to Excel Act as Enrollment Specialist when needed, keeping track of sales leads and hours on Excel spreadsheet Utilize EZCAP, NextGen, Medicaid and Medicare websites to verify eligibility and audit reports Obtained certificate for Data Release Certified Requestor for Data Release Governance.
  • Maintained Team Lead position for Patient Care Coordinators after one year of hire.
  • Created training tools, workflows, and processes on Word, Excel and Adobe Acrobat Pro
  •  Analyzed processes and reports on Excel to improve their effectiveness Analyzed and compare patient eligibility thru AHCCS and Partnership Health websites Collaborated with national and internal department team members for creation of workflow process and job aides Tested prototype tools to increase efficiency in the workplace Worked in partnership with senior management teams to develop patient-focused content Collaborated across teams to share information and coordinate on new ideas at the weekly computer enhancement meetings.
  • Served as preceptor/trainer to all new hires Implemented knowledge of work flow process through training new hires.
Baptist Hospital - Pharmacy Technician
City, STATE, 02/2010 - 02/2012
  • Maintained prescription orders, PIXUS stock, and inventory Prepared IV bags, injections, and compound medications Performed inventory inspection on supplies and medications.
CVS/Pharmacy - Lead Pharmacy Technician
City, STATE, 08/1999 - 08/2006
  • Enhanced knowledge through company training courses Provided assistance and input when interviewing new hires Planned monthly schedule for coworkers Supervised seven employees as a team lead in retail pharmacy Produced training manuals and prior authorization manuals Performed inventory inspection with controlled and maintenance medications.
Activities and Honors
Leadership Development Program
Skills
  • 6 years of Adobe Acrobat and  Adobe
  • 3 years of Report Auditing 
  • 6 years use of Cisco phone system 
  • 3 years use of Citrix
  • 30 years customer service
  • 24 years healthcare field
  • 25 years of documentation and email usage
  • 13 years leadership and training experience
  • 24 years use of  Microsoft Excel, Excel, mail, Microsoft Office, Outlook, PowerPoint, Sharepoint, Windows 7, Microsoft Windows and Word
  • 6 years of Networking,  use of Pivot Tables, creating processes, Programming, protocols, quality, Rehabilitation, retail, sales, Shockwave, spreadsheet, SQL, phones, trainer, training manuals, VPN, VISIO, websites, WorkBench, workflow

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Resume Overview

School Attended
  • Grand Canyon University
  • Murray State University
  • Madisonville Community College
Job Titles Held:
  • Senior Disability Claim Manager
  • Associate Business Analyst/Lead Patient Care Coord
  • Pharmacy Technician
  • Lead Pharmacy Technician
Degrees
  • Masters of Business Administration and Management
  • Bachelors of Science
  • Associates of Arts

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