Wayne M. Hampton II

*** ****** ****** ****, *** Fl, Newark, NJ 07108 Phone: 646-***-**** e-mail: ac8dsc@r.postjobfree.com Objective: To secure long term and challenging employment with a progressive company, where there is room for advancement. Related Experience:

Clover Health 09/2016-07/2018 Jersey City, NJ

Customer Experience Coordinator

Provider Services 08/17-07/18

• Acted as the central point of contact for health care providers servicing Clover members, both inbound and outbound while ensuring consistent coverage

• Professional experience in Medicare, Medicaid, medical claims experience, prior authorization/utilization management experience, and billing

• Front line interaction with the providers in-regards to resolving claim discrepancies and providing further details

• Interacted with network management to ensure the flow of credentialing process and contract fees

• Collaborated with other team members such as other nurses, non-clinical staff, and providers necessary to meet customer needs and resolve issues

• Initiated the prior authorization and collection of clinical and non-clinical information

• Acted as liaison with client to identify issues and problems relating to care management and claim processing and forwards concerns to appropriate parties, when necessary

• Monitored and follow up on tasks escalated from vendors and field team

• Pre-service review of outpatient services, elective procedures, DME, and medical supplies

• Reviewed documents for internal and external request.

• Performed other relevant tasks and projects as assigned by management Member Services 12/16-08/17

• Acted as the central point of contact for members and providers for both inbound and outbound calls while ensuring consistent coverage on inbound customer service queue.

• Maintained clear and accurate logs of all customer encounters and their demographic information.

• Worked toward on-the-spot resolution to member issues that do not need escalation.

• Escalated members with complex care coordination needs to Case Management.

• Communicated cross-functionally with other departments as necessary to meet customer needs and resolve issues.

• Onboarded new Plan members by explaining benefits and resources.

• Provided member health education to assist with self management.

• Scheduled staff Nurse Practitioners and Social Workers for in-home member assessments.

• Assisted members with provider referrals and office visit scheduling.

• Monitored and follow up on tasks escalated from vendors and field team.

• Triggered mailings to members as needed.

• Completed ad hoc duties as needed.

Broker Support Specialist 09/16-08/17

• Became the trusted source of information to internal and external sales agents who will help them hit their sales goals

• Delivered best-in-class customer service to all callers, building loyalty to Clover as the best brand in the market to work with and sell for

• Handled inbound calls and requests from our external sales team, including questions to help drive sales productivity or operational hurdles in working with Clover

• Managed (verbally and in writing) ongoing service issues with external sales agents from intake through to resolution

• Utilized Clover's suite of tools to help investigate and solve issues/questions in real-time

• Documented each service issue in a common CRM to ensure proper resolution and escalation

• Researched questions from internal and external sales agents to help them drive sales productivity in the field

• Worked cross-functionally to investigate and solve problems that are managed by other Clover teams

• Flagged common issues coming through Broker Support that could be better addressed in other channels or with more scalable and efficient processes

• Help build the top Broker Support unit in the Medicare Advantage space MTA New York City Transit 03/2013-01/2016 Brooklyn, NY Conductor 06/14-01/16

• Safe, timely and proper operation of MTA New York City Transit’s train doors in costumer, yard and work train service

• Opened and closed train doors when in customer service when safe to do so as to prevent customer injury

• Made proper announcements to customers in reference to service changes, transfer points and train destinations and set up the automatic announcement system as well as assisted customers with establishing the most efficient route to their desired destination

• Patrolled platforms as to assist customers in safely entering and exiting trains during rush hour and notify them of service changes

• Operated hand-thrown switches in the yards

• Made reports of unusual occurrences.

Train Operator 03/13-06/14

• Safe, timely and proper operation of New York City Transit Authority multi-unit subway cars, subway service cars and trains in accordance with the rules, regulations and special instructions governing such operation

• Prepare trains for road service and switch cars in yards, in revenue road service

• Convey service information to passengers.

NYC Department of Education 09/2007- 05/2011 Brooklyn, NY HR Connect Customer Information Representative

• Assisted internal and external customers, via high volume call center and in person, through a variety of circumstances including, but not limited to, on- boarding, certification, background checking, separation from service, and payroll.

• Tier 1- leaves specialist, medical/health benefits specialist.

• Updated and maintained personal and tax data information for DOE employees

• Fingerprint imaging for background check for DOE applicants GHI- Medicare COB Contract 12/2002-05/2007 New York, NY Certified Medicare Coordination of Benefits Specialist-Tier 2

• Via high volume call center, assisted Medicare beneficiaries, insurers and employers determine primary insurance payer based on Federal primary payer law

• Updated and maintained personal data and primary insurance payer records as per Federal HIPAA regulations Thieme Medical Publishers 08/1997-10/1997 New York, NY Shipping and Receiving Manager

• Shipped materials, both domestic and international, via various shipping companies, (US Mail, UPS, FedEx and DHL)

• Received and distributed incoming mail and parcels throughout office to appropriate stations

• Responsible for the rotation, distribution and inventory management of office supplies

• General office maintenance and reception and switchboard desk coverage UFT Welfare Fund 11/1989-07/1996 New York, NY

Insurance Claims Examiner 09/93-07/96

• Processed dental, optical and disability insurance claims forms as per United Federation of Teachers benefit guidelines

• Via phone and in person, assisted teachers in overcoming issues pertaining to and understanding dental, optical and disability claims

• Maintained and updated personal data

• Covered reception and switchboard desks

Shipping/Receiving Clerk 11/89-09/93

• Shipped materials, both domestic and international, via various shipping companies, (US Mail, UPS, FedEx and DHL)

• Received and distributed incoming mail and parcels throughout office to appropriate stations

• General office maintenance

A. Philip Randolph Institute 06/1986-08/1989 New York, NY Shipping and Receiving Manager

• Shipped materials, both domestic and international, via various shipping companies, (US Mail, UPS, FedEx and DHL)

• Received and distributed incoming mail and parcels throughout office to appropriate stations

• Coordinated, collated and shipped materials for AFL-CIO National Labor Conferences and distributed those materials at said conferences

• Responsible for maintaining and updating inventory of AFL-CIO brochures, posters and pamphlets

• Updated and maintained member database

• General office maintenance

• Label printing for mass mailings

Education: Springfield Gardens High School, Springfield Gardens, NY: Regents Diploma, August 1988 Certifications: HIPAA Certified; 8 Hour Security Guard Certification Formerly Certified: A+, N+ and Microsoft Office ‘97

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