Highmark Health

Service Claims Rep Blue Card

EXL Trumbull Services

● Improving new hire orientations and onboarding processes, as well as implementing an employee wellness program, resulted in a 7% increase in employee retention and a 5% increase in business optimization.
● Coordinate medical personnel's schedules and staff training programs in adherence to company policies as well as health care laws and regulations, which has also contributed to the 7% increase in employee retention and a 25% increase in the overall patient experience based on the previous 2 years of patient satisfaction surveys.
● Develop and manage scope, schedule, and budget for each project.
● Provide a measurable and timely response to client inquiries, work requests, and concerns.
● Communicate directly with clients to define project goals and provide reports on project status and variances.
● Coordinate a project team of key stakeholders, internal team members, and vendor partners who meet the deliverables
of the project.
● Develop and maintain complete knowledge of vendor service and material capabilities, processes, and deliverables.
● Ensure that projects run smoothly and on schedule by proactively identifying risks and appropriately escalating
concerns and potential solutions to impacted parties.
● Route and book FOB and DDP orders.
● Process invoices in the internal system.
● Route customer orders and track deliveries in a timely manner.
● Monitor shipment status and discrepancies, and work with customers to provide solutions.
● Maintain accurate open order logs and communicate updates to both the purchasing and operations teams.
● Liaise and negotiate with suppliers, manufacturers, retailers, and consumers.

Assistant Project Manager

GEICO

● Maintained staff by recruiting, selecting, orienting, and training employees, decreasing the learning curve by 10%.
● Developed personal growth opportunities, improving overall employee satisfaction by 15% based on the previous 2 years of employee satisfaction surveys.
● Resolved claim issues promptly and followed up on outstanding issues; analyzed, planned, made decisions, and solved problems to support claim settlement, which resulted in an individual customer satisfaction score of 95% based on the previous 4 years of customer surveys and an overall team customer satisfaction score of 98% based on the previous 2 years of customer surveys.
● Completed operations by developing schedules, assigning and monitoring work, gathering resources, implementing productivity standards, resolving operations problems, maintaining reference manuals, and implementing new procedures.
● Evaluated the facts of loss of auto claims and examined file materials (police reports, recorded statements, photographs, etc.) and determined liability for auto claims.
● Presented persuasive arguments through written contentions and gathered evidence.
● Maintained quality claim filings in accordance with department expectations.
● Communicated effectively with customers, insurance agents, police, attorneys, and other public personnel involved in the claim process.
● Ensured that the claims were not fraudulent.
● Negotiated settlements and authorized payments, while keeping records of all actions for the customer’s file.
● Handled over 50 customer calls per day.

Auto Claims Representative, Supervisor & Arbitration Clerk

Blocher Homes

● Prepared course materials, such as syllabi and handouts, for distribution or use within the training class and introduced new learning tools to address individual needs, decreasing the learning curve by 5%.
● Trained and mentored approximately 15 employees, contributing to the 5% decrease in the learning curve and increasing employee retention also by 5%.
● Monitored over 30 residents a day.
● Determined specific needs and provided appropriate levels of services for residents’ well-being.
● Documented residents' mental status, sleep, and eating patterns in medical record books.
● Consulted with supervisors to assess cases and plan strategies for enhancing care.
● Planned, prepared, and served meals and snacks according to prescribed diets.
● Provided assistance to residents with respect to personal care, including feeding, bathing, dressing, grooming, and toileting.

Personal Care Aide & Coach

Dedicated and ambitious healthcare professional with clinical and operational experience, as well as a track record of meeting company goals through consistent and organized practices. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand.

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