Customer Service Sales Representative

SUMMARY

Dedicated Operations Trainer with proven success and expertise in

developing quality employees for health care companies and reducing

turnover attrition.

QUALIFICATION SUMMARY

Proven history of delivering quality results and eagerness to take on new

responsibilities.

Strong team leader who establishes goals and motivates employees to achieve

objectives

Over 3 years of experience in a healthcare environment, interacting with

customers and coworkers

Extensive knowledge and experience in the Health Insurance field

Dedicated and hardworking, with an unmatched drive to produce results

EMPLOYMENT HISTORY

US Army, Various, Various

Avenger Crewmember

7/1997 - 4/2002

Operated multi million dollar weapon system.

Received 1 Army Commendation Medal, 2 Army Achievement medals, 2

Army Good Conduct Medals and 1 National Defense Medal.

Toys R Us, Riverside, CA

Sales Rep

10/2002 - 2/2003

Supervised back room operations and monitored shipping and

receiving. Compiled daily reports to show efficeincy of orders.

Suncoast Motion Picture Company, Riverside, CA

Assistant Manager

8/2003 - 12/2003

Maintained store operations and provided customer service on a daily

basis. Communicated with vendors and companys to maintain stock on

shelves and promational materials in store.

Managed team of four part-time and nine full time employees

Established and maintained clean, professional and profitable

retail outlet location

Developed new method of stocking shelves resulting in a 25% time

savings when receiving weekly deliveries

Imperial Supplies, Green Bay, WI

Sales Representative

12/2005 - 5/2006

Maintained exsisting account base while expanding to different

account holders.

Loomis and Fargo, Green Bay, WI

Armored Guard

6/2006 - 2/2007

Ensured safe delivery and pick up of money transportation.

Maintained accurate data in transfer of money to clients

Performed the work previously required of two full-time employees

United Heath Care, Green Bay, WI

Customer Care Professional

2/2007 - 7/2007

Respond to complex customer calls

Resolve customer service inquiries which could include:

Benefit and Eligibility information

Billing and Payment issues

Customer material requests

Physician assignments

Authorization for treatment

Explanation of Benefits (EOB)

Provide excellent customer service

Constantly meet established productivity, schedule adherence, and

quality standards

United HealthCare, Green Bay, WI

Health Advisor

7/2007 - 2/2008

Assist members with selecting the best benefit plan options

available to them through the enrollment process, including

enrollment in specialized care programs

Resolve member service inquiries related to:

Medical benefits, eligibility, and claims

Financial spending accounts

Pharmacy benefits, eligibility, and claims

Correspondence requests

Educate members about the fundamentals of consumer-driven health

care including:

Managing health and well being

Maximizing the value of their health plan benefits

Choosing a quality care provider

Premium provider education and steerage

Own problem through to resolution on behalf of the member in real

time or through comprehensive and timely follow-up with the member

Help members navigate myuhc.com and other UnitedHealth Group

websites by co-browsing and locating information online with the

member

Intervene with care providers on behalf of the member

Research complex issues across multiple databases and work with

support resources to resolve member issues

Assist members with provider appointment scheduling

Connect members with internal specialists for assistance when needed

Partner with Appeals Coordinator to resolve escalated issues

Provide education and status on previously submitted

pre-authorizations or pre-determination requests

United Health Care, Green Bay, WI

Operational Trainer

2/2008 - Present

Delivering, measuring and facilitating training

Training Call Center Representatives and Transaction Associates

Training on various technical subjects

Assisting with the development of curriculum as needed

Experience working as a claims rep associate, claims

processing/adjusting, or a background working with medical insurance

or employer benefits

Proficiency in Microsoft Office applications

The ability to teach and present to others

Experience training others

Experience working in the health insurance industry

Received SPOT award for best CPI Index score for the first quarter

of 2009 and 2nd quarter of 2010.

Spearheaded the use of a new operating system for call and claims.

Integrated System Enhancement Tool.

Received multiple awards for excellence in training development.

EDUCATION

30 credit hours from completion - Riverside Community 2003 - 2005

College, Riverside, CA

Fort Bliss Air Defense School, El Paso, TX 1997

Ramona High School, Riverside, CA 1997

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