Customer Service Representative

Maile Ann Louie

**** ***** ****** **** * * Clearwater, Florida 33760 * Cellular: 727-***-**** * ***********@*****.***

HEALTHCARE SPECIALIST

Health Insurance Sales / Auditing/ Medical Management/Credentialing

Managed Healthcare Compliance

Medicare Part B and D and Commercial Insurance Claims and Billing

Specialized in Medicare Part D, Low Income Subsidy, and Commercial Pharmacy Contracts

Audit Insurance Claims and Billing Control Waste, Fraud and Abuse

Customer Service Representative Supervisor and Team Lead

International Medical Marketing

Health Insurance Agent (Florida, NY)

Work Experience:

HEALTH INSURANCE AGENT 2-15

Quality Health Plans of New York/GEOTICAL

October 2017- Current

Sales agent for private health insurance

Medicare Advantage sales

Medicare Supplemental Plans sales

Custom carve plan according to insured’s needs

Assist clients health insurance claims questions regarding health plan

INTERNATIONAL BUSINESS AND MARKETING LIAISON

GMedPro,

October 2016-September 2017 (see below) September 2011- October 2013

Pompano Beach, FL

Contact international customers interested in joining GMedPro exclusive distribution and marketing US made medical products in Turkey, Northern Africa and UEA.

As an emerging company, successfully contracted 152 US medical manufacturing companies to GMedPro’s growing number of clients.

Increased distribution and sales from 25% in 2011 to 65% in 2013.

Operated and managed inventory purchasing for projected sales and distribution.

Attend international trade show events representing GMedPro

Increased overseas sales from 65% to 89% from December 2016 to June 2017.

Operated and managed inventory purchasing for projected sales and distribution.

Attend international trade show events representing GMedPro

CUSTOMER SERVICE MEDICARE DEDICATED SERVICE DEPARTMENT

Claims/Medicare Part D

Amerivantage/Anthem,Tampa, Florida

September 2013 – September 2016

Take daily calls to resolve provider claims and appeals issues and member questions and inquiries regarding their MA medical benefits.

Successfully implemented Medicare Part D into the CSR knowledge base decreasing Member wait time by 87%.

Promoted to Team Lead for Medicare Part D

4 cases of Waste, Fraud and Abuse.

INTERNATIONAL BUSINESS AND MARKETING LIAISON

GMedPro September 2011- October 2013 (See above) February 2017-September 2017

Supervisor, Pharmacy Authorizations/Customer Service Department

Universal Healthcare

August 2007–August 2011

Supervised a team of 15 to 20 Customer Service Representatives regarding pharmacy inquires for pharmacy benefits for Medicare Part D Members and Low Income Subsidy Pharmacy Recipients.

Reviewed medical records with Utilization Management team for Brand Name medication necessity versus generic medications appeals

Maintained a 95% Member satisfaction rate.

Customer Service Representative audits averaged 92% per quarter.

Personally trained all Customer Service Representatives on Medicare Part D, Low Income Subsidy Recipients and met with each team member each month on client/provider satisfaction and inquires.

Maintained a 77% Customer Service Representative Employee retention level.

Voted “Best Customer Service Manager” three times.

SUPERVISOR, CUSTOMER SERVICE REPRESENTATIVE FOR MEDICAL CLAIMS AND PHARMACY DIVISION

Health Plan Services, Tampa, FL

November 2002-July 2007

Supervisor of Customer Service Department. Support team regarding questions from providers, members, benefits administrators regarding claims, member enrollment and appeals

Average handle time per call 5 minutes.

Average wait time for callers thirty seconds to two minutes

Reviewed medical records regarding appeals regarding medical necessity on high end medications with HealthPlan Services’ Nurse Practitioner Staff.

Overrode all pharmacy overrides in conjunction with Caremark.

Negotiated and interacted with Health Benefit Administrators and CEO/CFO’s for commercial insurance plans and pharmacy negotiations

Maintained a 85% retention rate with Customer Service Representatives

Mentor team regarding audits.

Update and educate team members on new computer systems and updates on medical contracts

LICENSED AGENT: LIFE, ANNUITY AND HEALTHCARE 2-15: Florida, Montana, Nevada, Utah, Colorado, Texas, Arizona, New York

EDUCATION AND PROFESSIONAL AFFLIATIONS/ACTIVITIES

Bachelor of Science, Psychology, University of Utah, Salt Lake City, Utah

MA Sports Management. NCAA Compliance, drug compliance and testing

Internship with the National Collegiate Athletic Association (NCAA) Division of Intercollegiate Compliance. Focus on allegations of intercollegiate non-compliance, drug testing and analysis.

Internship with the National Basketball Association( NBA) Department of Scheduling, Department of Compliance

Assistant to the Vice Chairman, Utah Winter Olympic Committee Compliance

Contact this candidate