LANCE Y TROH

**** **** **. *** *********, CT ****4 857-***-**** (M) act5i0@r.postjobfree.com

A dynamic, qualified and highly ethical professional providing key support in the areas of Data Analysis, Health Exchange Program, Project Management and Lean Six Sigma. Expert in analyzing data, resolving problems and providing superb customer service to personnel; experienced in writing comprehensive reports and creating compelling presentations. Experienced in developing process improvements that streamline workflow, and decrease waste. Excellent in working with business owners, senior-level executives, board members, and key stakeholders to develop strategic goals and action plans. Charismatic public speaker and dedicated client advocate who adapts quickly to changing environments and demand.

AREAS OF EXPERTISE

Logistics

Client Relationships

Principles of Lean Six Sigma

Bilingual – French/English

Strategic thinking

Data Maintenance

Analytical

Excellent Communication Skills

Customer Service

Excel

Team Leadership

Focus under pressure

MS Office Skills

Sale Operations

PROFESSIONAL EXPERIENCE

Claims Appeals/Resolution Analyst 12/2015-Present

UnitedHealth Group

•Review, research and understand how a claim submitted by consumers and physicians/providers was processed and determine why it was denied

•Identify and obtain all additional information (relevant medical records, contract language and process/procedures) needed to make an appropriate determination of the appeal on the claim

•Make an appropriate determination about whether a claim should be approved or denied based on the available information and research

•Determine whether additional appeal or grievance reviews are required and/or whether additional appeal rights are applicable and then if necessary, route to the proper department for their review and decision/response

•Complete necessary documentation of final documentation of final determination of appeals or grievance using the appropriate templates, communication process, etc. (e.g. response letters, customer service documentation)

•Communicate appeal or grievance information to members or providers with the required timeframes well as to all appropriate internal or external parties (regulatory agencies, plan administrators, etc.)

•Meet the performance goals established for the position in the areas of: efficiency, accuracy, quality and member.

Self Employed 04/2015 – 12/2015

Applied Behavior Analysis-Consultant

One-on-one interaction to children within the Autism Spectrum Disorder [ASD].

Fostering essential learning skills, documenting progress and reinforcing positive behaviors.

Give direction, motivate and guidance to parents while directing short and long term goal.

Key Achievement:

Improved children behaviors skill by 70% from 30% within the first 2 months.

WESTCHESTER DISABLED ON THE MOVE, INC., Yonkers, NY 08/2013 – 03/2015

Health Exchange Navigator Program Coordinator

Operated the New York Health Exchange Program by successfully completing over 1000 individuals

application.

Developed marketing information, manage outreach projects, conducted community outreach activities and enforced compliance with state and federal regulations.

Conducted monthly reporting and evaluate the program to improve productivity, consumer awareness, and support process improvement.

Response to consumers’ calls promptly, appeal denial applications, attends state training, meeting and solves complex project assignments.

Key Achievement:

Reduced consumers’ healthcare spending by 60%.

Resolved 90% of grievances/appeal cases.

Seventy percent of consumers got a better understanding of their healthcare during their appointment.

Increased enrollment by 150% within the first six months of enrollment.

Increased WDOM contract bonus within the first six months.

Listed as one of the top navigators within Westchester County for agency that contracted from the Community Service Society (CSS) of N.Y.

ADVOCATES, INC., Dedham, MA 08/2012 – 08/2013

Direct Care Counselor

Performed interventions with clients that address their identified goals and result in skill development.

Provided ongoing support, guidance, role modeling and supervision to clients.

Monitored and document medication administration.

Developed and documented Program Specific Treatment Plans (PSTPs) and reviews, outlining rehabilitative goals and interventions, which reflect program participant preference and meet Department of Mental Health and Agency standards, with supervisor's direction.

Key Achievement:

Reduced client medication error.

Promoted client and staff relationship by creating feedback postcards.

EDUCATION

Lean/DFSS Green Belt-2015, Aveta Business Institute License # 600**********

MPH: Health Policy and Management, New York Medical College, Valhalla, NY

Emphasis in Health Policy and Management

BSPH: Public Health, Southern Connecticut State University, New Haven, NY

Member of the American College of Healthcare Executives (ACHE)

ACHE Albert W. Dent Graduate Scholarship Recipient (2015)

CTAHE Ignition Business Coach Executive Coaching Program Recipient (2015)

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