Senior Health Plan Representative resume example with 20+ years of experience

Jessica Claire
Montgomery Street, San Francisco, CA 94105 609 Johnson Ave., 49204, Tulsa, OK
Home: (555) 432-1000 - Cell: - - -

Enthusiastic Healthcare Professional seeking an administrative or operational position that supports leadership in their organizational efforts to provide successful and sustainable patient care.

  • Healthcare operations
  • Health plan coverage & benefits
  • Healthcare management
  • Quality & regulatory auditing
  • Goal planning & team building
  • Defining & coordinating project plans
  • Coordination of training & development
  • Safety and health standards
  • Forecasting and scheduling
  • Health inspection preparation
  • Experienced in healthcare systems: EPIC and Foundations Healthcare Systems
  • Experienced in Microsoft Office Applications and Google Applications
10/2018 to Current
Senior Health Plan Representative Wilson Memorial Hospital Sidney, OH,
  • Assist the Health Plan Operations Director with complex projects pertaining to health plan regulations in collaboration with healthcare administrators in both inpatient and outpatient settings
  • Support physician reviewers with second opinion pre-grievance referrals adhering to regulatory guidelines set be the Department of Managed Healthcare (DMHC), Centers for Medicare and Medi-Cal (CMS), and Joint Commission on Accreditation of Healthcare Organizations (JACHO)
  • Supervise daily functions of Health Plan Representatives for the Marin/Sonoma Service Area by reviewing grievance and inquiry case documentation and providing training on current regulatory guidelines
  • Perform monthly internal audits of Health Plan Representative inquiry cases that pertain to healthcare services and health plan coverage benefits
  • Unit Based Team Co-lead supporting the Member Services Department by facilitating monthly meetings, creating team agendas, creating project mapping tools, compiling data and taking detailed meeting minutes per the Regional Labor and Management Agreement and expectations (SEIU-UHW)
  • Prepare and present formal presentations given to all departments within Kaiser Permanente focusing on Member Services Department functions and workflows
03/2000 to Current
Clinical Medical Assistant Mettler Toledo Columbia, NC,
  • Provided clinical and administrative support to sub-specialty physician chiefs and their colleagues (Infectious Diseases, Oncology, Nephrology, Cardiology, Pulmonology, and Chemo Infusion Center)
  • Processed referrals
  • Managed clinic schedules and physician hospital on-call schedules
  • Coordinated patient scheduling for multiple sub-specialties in collaboration with diagnostic imaging and laboratory departments, Home Health, and Skilled Nursing Facilities
  • Coordinated outpatient PICC line placements with the Kaiser Satellite Infusion Center for the Infectious Diseases Department while working 10 years in the Infectious Diseases Department
  • Coordinated presentations, meetings, and Tuberculosis, Zika Testing, HIV/STD, PrEP Clinics with the California Department of Public Health and the Sonoma County Department of Public Health while working 10 years in the Infectious Diseases Department
  • Tracked and managed inventory for exam rooms, maintained vaccine and expiration logs, created Excel tracking spreadsheets for various patient populations
  • Promoted continuity of care by accurately and completely communicating patient status to fellow caregivers
  • Assisted physicians with minor surgical sterile procedures
  • Performed patient vital signs, wound care, and vaccinations documented in EPIC
  • Software experience: EPIC, Foundations Healthcare Systems, Microsoft Office Applications, and Google Applications
05/1994 to 01/2000
Production Assistant New Zealand Milk Products City, STATE,
  • Prepared US and Canadian Customs documentation for the import of milk and whey proteins from New Zealand
  • Coordinated logistics (container and truck load arrangements) for foreign and domestic clients
  • Supported three Production Managers with the forecasting of large volumes of milk and whey protein manufacturing for sale in the US and Canada
  • Assisted Canadian Sales Representative by arranging production contracts for Abbott Laboratories and Bristol-Myers Squibb
  • Processed foreign and domestic contracts and purchase orders
  • Elected by NZMP Leadership Team to become ISO 9000 Certified as Internal Quality Auditor for all business operations
Education and Training
Expected in 05/2018
Bachelor of Arts: Business Administration And Management
Dominican University of California - San Rafael, CA
Expected in 06/1984
High School Diploma:
Immaculate Conception Academy - San Francisco, CA,
Additional Information

Dominican University of California, San Rafael, CA

Presented: International Honors Society in Business, Management, and Administration

Presented: Honors Society for Adult Learners in Continuing Higher Education



Boston Reed, Santa Rosa, CA

Clinical Medical Assistant Certification

February 2000

International Quality Management and Systems Standards Certification Program

Certified ISO 9000 Internal Quality Auditor

New Zealand Milk Products

August 1998

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Resume Overview

School Attended

  • Dominican University of California
  • Immaculate Conception Academy

Job Titles Held:

  • Senior Health Plan Representative
  • Clinical Medical Assistant
  • Production Assistant


  • Bachelor of Arts
  • High School Diploma

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