Customer Service Sales Representative

SUSIE SEACE

**** ******* ******** *****, ******, Texas 75062

(H) 972-***-**** (C) 972-***-**** ? (Email) *******@*******.***

Provider Network Director

SUMMARY OF QUALIFICATIONS

o Over 10 years of managed care experience.

o Experience in various levels of contract negotiations and provider

relations.

o Ability to work with professionals and coworkers due to exceptional

communication and people skills. Proficient in a variety of computer

skills.

o Saved the Foundation Health Federal Services over $125,000 by maintaining

a 95% physician retention rate. Delivers large group presentations with

professional skill.

o Creative problem solver with the ability to identify and resolve a wide

range of issues related to claims, human resources, benefits, and data

integrity.

o A team player that is very visionary, determined, dependable, empathetic,

and trustworthy.

PROFESSIONAL EXPERIENCE

UNITED MILITARY & VETERANS SERVICES(United HealthCare) 2010-Present

Health care organization located in Plano, Texas

Currently working with TRICARE Network Management and seeking position due

to uncertainty of the program.

CIGNA, Irving, Texas 2008-2010

Global health service company located in Irving, Texas.

Contract Negotiator (Home based)

? Renegotiate existing fee schedules for dental providers in assigned

territory.

? Track financial performance of contracts and ensure compliance with

contracting

guidelines.

? Support Network Segmentation and recruitment goals to position CIGNA

Dental for growth.

Major Accomplishments:

? Successfully reduced PPO turnover rate of 3.0% or less.

? Achieved overall discount minimum of 28.5%(Average Area Charge) or

less on renegotiated

contracts.

? Contributed to national goal of DHMO unit cost containment in

territory.

? Reduced PSU alert turnaround time to 21days.

ANCILLARY CARE SERVICES (ACS), Dallas, Texas 2004-2008

Comprehensive ancillary care service provider headquartered in Dallas,

Texas.

Contract Specialist

? Recruit specific ancillary providers on behalf of clients for Group &

Workers Comp product.

? Recruit out of network providers to enhance provider network.

? Analyze fee schedules that identified competitive reimbursement.

? Maintain database pertaining to data integrity, credentialing and

network development.

Major Accomplishments:

? Renegotiated 200+ providers that yielded a positive profit margin.

? Recruited top revenue providers resulting in $6 million dollars to ACS

bottom line.

? Continue to achieve monthly recruiting goal of 1,000 provider sites a

month.

? Top ancillary recruiter in 2007 thus resulting in cost savings to the

client and increased

the provider network by 30%

PUBLIC EMPLOYEE BENEFITS COOPERATIVE (PEBC), Arlington, Texas 2002-2004

Texas Employees Cooperative managing state benefits packages headquartered

in Arlington, Texas.

Benefits Representative

. Administer a wide range of tasks and processes to maintain multi-employer

programs for Dallas, Denton, Tarrant County and North Texas Tollway

Authority.

. Communicate daily with employees, internal staff and vendors to resolve

inquiries including claims issues, COBRA administration, billing, Health

Maintenance Organization (HMO), and medical/dental plans.

. Perform data analysis, summarize statistical and qualitative HMO data to

support trend and benefit design decisions.

. Track and identify solutions for operational and data integrity issues

and maintained confidential files and records. Assist with the

enrollment process and reconcile eligibility data between vendors and

members, including retiree and COBRA billing.

Major Accomplishments:

. Saved the Cooperative several thousand dollars by managing benefits

program for 1,200 county employees.

. Created in-house management benefits literature decreasing the county

budget by $2,000.

. Conducted several seminars for county employees, which were recognized by

the PEBC for outstanding Quality and Performance of the presentations.

. Recognized for exceptional customer service and timing skills by

superiors, state agencies and vendors.

PROFESSIONAL DETAILING INC., Upper Saddle River, New Jersey

2000-2002

A National multi-million dollar contract sales organization, headquartered

in Saddle River, New Jersey.

Sales Representative

. Sold and marketed Cipro, Avelox and Baycol drugs for Bayer Pharmaceutical

to health care professionals.

. Traveled the South Dallas territory selling products to Doctors, Clinics

and Hospitals.

Major Accomplishments:

. Achieved 8.4% increase over quota for Cipro sales in 2002.

. Doubled quota for Avelox products by significantly exceeding market share

growth.

. Recognized by management for quality record keeping and consistent follow-

up.

FOUNDATION HEALTH FEDERAL SERVICES, Irving, Texas 1999 -

2000

A National Managed Care company handling all Tricare health services for

all branches of the military, headquartered in Rancho Cordova, California.

Provider Relations Representative

. Recruited physicians and other healthcare personnel for managed care

company.

. Performed Internet research to determine leads and initiated cold calling

for appropriate candidates. Administered reimbursements, benefit

structure, and termination.

. Analyzed reports & statistical data to support recruitment trends.

Major Accomplishments:

. Saved the company over $125,000 with a 95% physician retention rate.

. Managed and supported territory of 1,500 providers.

. Conducted seminars and presentations at key locations across the Dallas

Metro Area.

EDUCATION

Bachelor of Science, Healthcare Administration; 1992 - 1996

Texas State University, San Marcos, Texas

(Formerly Southwest Texas State University)

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