Customer Service Business Analyst

Jose C. Figueredo Jr

813-***-**** • ad07b2@r.postjobfree.com

Key Administrative Skills

Coaching and Mentoring

Combine Planning

Communication

Leadership

Time Management

Organizational Skills

Microsoft Office

Medical Software’s

Claim Processing

Customer Service

Sales

Problem-Solving

Professional Experience

CENTENE CORPORATION February 2022 - Present

Business Analyst II

oManaging provider accounts for the state of Hawaii.

oEstablishing project plans, gap report analysis, and process improvements.

oServes as liaison between providers and insurance companies.

oHandling all claims: overpayments, underpayments, denials, and disputes/appeals & grievances.

INTEGRITY EXPRESS LOGISTICS September 2021 – February 2022

Logistic Account Executive

oCold calls to establish customer relationships.

oCreates logistics plans for carriers.

oServes as dispatcher for carrier and customer needs.

oHandles all claims and damages to product.

oCreate relationships with customers to ensure top tier customer service.

WELLCARE HEALTH PLANS, ACQUIRED BY CENTENE CORPORATION November 2014 – September 2021

Operations Supervisor (February 2018 – September 2021)

oManages/oversees projects, audits, and active holds inventory.

oEstablish project plans, gap report analysis and leadership updates.

oServes as a first line resource for operation/claims questions.

oHandles complex case research/resolution situations.

oReviews direct reports timecards, flex schedules and paid time off reports.

Configuration Specialist (July 2016 – February 2018)

oEnsure providers are loaded with correct demographics and contract pricing.

oWork with internal departments to resolve pricing and loading issues.

oOperate daily aging reports to meet our TAT requirements.

oAssist in creating new price rules and contract laying.

oPerform testing to merit new contract layers.

Claims Specialist II (April 2015 – July 2016)

oPerform Ad Hoc projects or reporting request as needed to support the Claims Dept.

oProcess claims that pend and provide final determination for claim disposition

oImplement true Root Cause analysis to provide resolutions and method improvements

oWork with external organizations (i.e., CMS) to help resolve member and provider claim problems.

oLiaison between internal partners to coordinate initiatives for problem solving and research analysis

Member Engagement Specialist (November 2014 – April 2015)

oRoot cases to Care Management Program through assigned online queue systems.

oProvide client specific screenings.

oUpload/Document Health Risk Assessments into SharePoint/EMMA tracking system

oOperate daily Census and multiple reports to perform member outreach

Education

High School Diploma - Hillsborough High School – Tampa, FL 2006-2010

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