Aundrea Everlyn Angelo

ad1igm@r.postjobfree.com

209-***-****

SUMMARY

Ability to work independently on multiple tasks and prioritize.

Good verbal and written communication skills.

Demonstrated sound independent judgement and strong analytic ability in solving complex and sensitive issues. Knowledge of policy processing and documentation.

Knowledge of applicable insurance products.

Knowledge of standard business policies, practices, and procedures.

General understanding of basic analytical and financial techniques.

Maintain an understanding and adheres to State specific statuses involving underwriting, applicable insurance laws and regulations.

Take on a leadership role responsible for all aspects of underwriting initiatives for some well-known reinsurance contracts providers.

Experienced professional with problem solving and effective issue resolution skills.

Communicate effectively and have established customer service and client-facing experience.

Well organized with handling and completing workloads.

More than 25 years of supervisory and Human Resource experience.

Work well under stress and meet all assigned guidelines proving excellent time management skills.

Excellent support for all managers and co-workers.

CERTIFICATAIONS & TECHNICAL SKILLS

Epic Tapestry Core Certified

Microsoft Office 2016 Windows 11

10-Key data entry and typing skills

Certified Medical Manager (PAHCOM)

Licensed Vocational Nurse: Samuel Merritt School of Nursing.

EDUCATION

Associate of Arts Humphrey Business College of Stockton CA

Bachelor of Arts (BA) of Biblical Studies and Master's Religious Education, Sacramento Theological Seminary and Bible College, Sacramento, CA (Completed).

Doctor of Humane Letters. Christian University of Southern Indiana.

Pacific Home Care

Case Manager/Patient Caregiver

January 2018 – Current

Assist clients with personal care, including dressing, mobility, administering medication, personal hygiene, eating and transporting to doctor’s appointments.

Working with a culturally diverse population, including but not limited to internal and external entities and stakeholders to achieve exceptional results in the areas of compliance, documentation, benefits/contract information, appeals, and risk.

Monitor patient medications and update health charts

Maintain open communication between families and health care professionals regarding client’s medical and emotional condition.

Document and report any changes in client’s health status

Ensure highest client safety and well-being

Job SUMMARY

San Joaquin County

SJ Health Call Center

April 2022—December2021

Schedule appointments for over 65 county doctors and clinical staff.

Send over 50 electronic messages to various clinics and doctors a day.

Register all new patients and verify all insurances. (Medicare, Medical, Health Plan of San Joaquin, Medcore and other contracted insurances.

Receive and facilitate over 80-100 calls a day.

Use of multiple and various apps. (Cisco, DRE, Availability software for Medical/Medicare Eligibility, Microsoft Outlook, PeopleSoft).

San Joaquin Register of Voters (ROV)

7585 South Longe Street Stockton, CA 95206

Daylin/ 209-***-****

Election Technician

August 2021- October 2021

Assist members of the public who come to a Voting Center.

Set up, program and test all voting machines and voting materials.

Scan and count and verify all ballots.

Knowledge of Departments voter registration database and other applications and resources

Standing for 3-6 hours at a time. Work 40-70 hours as required. Handling and lifting 30-40 pounds.

Ability to learn new subject matters in a short period of time. Multi task/ simultaneously working on several task at the same time with accuracy at all times.

Kaiser Permanente, Oakland, CA

Senior Business Process Analyst, KP Claims Connect Program

October 2013 – June 2017

Patient Advocacy managing, processing and auditing internal complaints, grievance, risk, and appeals cases.

Monitored the case processing and resolution of highly escalated and politically sensitive Patient grievances, which included quality of care, efficiency and service, request for service, monetary disputes and appeals.

As a part of the grievance process provided written and verbal documentation to patients.

Supported User Acceptance testing activities for the implementation of Tapestry AP Claims in HI, CA, NW, and CO regions.

Manage to resolve member's complaints, Appeals and Grievances, including transcribing the members concern, research and give timely resolution.

Assist and educate member service agents when they need assistance or knowledge of how to handle various issues.

Getting authorization to get certain codes to get claims paid.

Created and monitored underwriting standards and guidelines.

Performed system integration testing on Formworks Claims Intake application. SQL program writing.

Followed desk level procedures to finalize claims in Tapestry, by resolving hold/pend codes.

Served as team's subject matter expert in creating Referrals/Authorizations accuracy required to ensure correct payment and correct GL string.

AP Claims processing. Adjudication, CRM, Contracts, Eligibility Referrals, and full auditing for correct processing.

Certified in Epic Tapestry Core. (2017).

March 2009 – October 2013

Blue Shield of California, Lodi CA

Senior IFP/Case Manager/Underwriter

September 2003 - March 2009

Developed underwriting policies for facultative reinsurance contracts.

Created and monitored underwriting standards and guidelines.

Respond in writing every denial of coverage and every rated-up application.

All grievances had to be reviewed and responded to within a week.

Decision making was made with the applicant in mind also with consideration of the client and the company.

Underwrite endorsement, reinstatement and cancellation transactions; all within prescribed authority levels.

Pursues missing information from applications, endorsements and other written correspondence by contacting brokers, agents, and customers for resolution.

Process underwriting referrals for new and renewal business and endorsements within underwriting authority.

Analyzes data (year build, square footage, brush) and prepares recommendations for Underwriter.

Performs data entry of insurance requests within underwriting authority.

Supports Underwriters by performing a variety of data collection and file preparation work. Includes completing research for multiple products.

Takes agent calls, answers and resolves service-related questions.

Conduct policy reviews ensuring compliance with underwriting rules, policies, practices, and procedures.

Works independently and exercises judgment in the selection and interpretation of data, and prioritization of work.

May update underwriting system.

Work with Compliance on responses to DOI complaints made by insured.

Requests underwriting and/or state mandated requirements, based on Guidelines.

Performs other related duties as required and assists with special projects.

Reviewed all applications and medical history for appropriateness and applied ratings for acceptance/denial in accordance with policy guidelines.

Worked directly with account managers to adjust rates in accordance with member's medical history and group loyalty without increased risk.

Demonstrated knowledge of insurance coverage and underwriting guidelines.

Identified and implemented methods to retain groups in good status while reducing risks.

Developed and collaborated with Business Development to fosterer an environment focused on profitable, sustainable business, while maintaining an excellent rapport with the account managers which consistently improves customer satisfaction.

Assisted in the research, development, and implementation of underwriting rules, severity scores, and data interpretation procedures.

Trained staff underwriters on integrated standards and guidelines.

Blue Shield of California, Lodi CA

Call Center Customer Service Supervisor

May 2002 - November 2002

Hired, trained and retained talented team members.

Supervised staff of 30 representatives.

Provided supervision for maintaining call center operations consisting of 3,000 calls per day.

Monitored call intake performance to ensure a 36-hour turnaround time for all follow up and correspondence resolution while demonstrating and maintaining professional demeanor.

Sun Bridge Hampton Health Care Center, Stockton, CA

Admission/Marketing Director

April 2001 - March 2002

Supervised a staff of 6 associates.

Provided management intake for receiving requests from case managers for patient admissions.

Researched and applied guidelines for appropriate insurance coverage responsibility, length of stay and patient liability.

Coordinated all patient discharge procedures and care instructions.

Family Practice Medical Group of Oakland, Oakland, CA

Practice Administrator

September 1993 - March 2001

Managed medical office consisting of 7 Physicians, 2 Nurse Practitioners and 15 Medical

Assistants within an operating budget of seven figures per year.

Hire, train and maintain dedicated staff.

Applies knowledge of Federal and State guidelines and regulations.

Operates within budget while maintaining profits.

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