CLIENT SERVICE MANAGER

Health Care – Insurance – Workers’ Compensation – PBM

Seasoned professional with proven expertise in Health Care Client Management, Insurance Applications and Workers’ Compensation. Excellent communication skills, shown through directly contacting, meeting with and coordinating with individual, as well as corporate clients to facilitate the correct flow of information to fully ensure total client satisfaction. Direct analytical skills, demonstrated by analyzing the necessary data sets to prepare and present Monthly, Quarterly, and Annual Reports on all aspects of the client experience to Executive Leadership teams, both internal and external. Computer proficient in the full Microsoft Office Suite. Adept at the supervision of staff.

Proven Areas of Expertise:

Member ID Conversions Client Account Management Adjuster Liaison

First Fill Programs Workers’ Compensation Laws Data Analysis

Claims Processing Direct Member Reimbursement Pharmacy Management

Relationship Specialist Training Clients and Customers Billing Reconciliations

PROFESSIONAL EXPERIENCE

Medical Assistant

Dec 2021 – Present

Creating systems to improve office flow charts. Setting up appointments with patients and doctors offices. Ensuring proper medical notes are sent to the referring physician. Sending patients for testing and receiving test results for doctor to review. Calling in prescriptions at pharmacy and doing prior authorizations. Working with insurance companies on prior authorization request for medications and procedures. Ensuring stock on any samples and scheduling drug reps to meet with doctor.

Realtor

Jan 2018 – Present

Real Estate agent working with clients to buy or sell their home. Handling of all legal

contracts deadlines. Assisting with appraisals and inspections on all properties. Working with

affiliated companies to ensure contracts are being executed. Maintain relationships active to continue future business. Marketing, follow-ups and CRM management. Continuing Education in constant improvement and staying current with law and statue changes.

OptumRx

Client Service Manager

June 2012 – October 2017 Telecommuter, Florida

A position dedicated to maintaining client accounts, including direct client interfacing, developing custom client programs, researching and resolving all client issues, as well as implementing First Fill programs and Member ID conversions for over 12 clients with more than 50,000 employees. Also responsible for establishing and documenting workflows and procedures, including State Specific Fee schedules for more than 10 locations in various states. Responsible for compiling, analyzing, preparing and presenting various, monthly, quarterly and annual reports across multiple data sets as needed by the clients and the internal Executive Leadership Team.

OptumRx

Workers’ Compensation Specialist

Jan 2009 – June 2012 Ft. Lauderdale, Florida

A position dedicated to the processing of claims for both Workers’ Comp. and DMRs. Responsible for verifying and coordinating information between, Pharmacies, Adjusters and Members, including the management and continued follow up for new and prior authorizations. Also responsible for all of the necessary and ensuing administrative tasks and projects for Workers’ Comp. clients and DMR groups. Additionally responsible to act as Team Lead upon the unavailability of upper management.

OptumRx

Compliance Specialist

Nov 2007 – Dec 2008 Ft. Lauderdale, Florida

A position primarily dedicated to the full understanding and correct application of each state’s unique laws to the various Workers’ Compensation cases handled simultaneously in over 50 states. Responsible for the weekly reporting to each State as to the status of their individual claimants cases. Also responsible for ensuring the entire corporation achieved and remained in compliance for Workers’ Compensation.

OptumRx

Accounting/Reconsiderations

July 2003 - Nov 2007 Ft. Lauderdale, Florida

A position primarily dedicated to the processing of payments, charges, and outstanding debts for over 45 clients and 50,000 members. Responsible for analyzing the Bad Debt accounts for each client and/or member, as well as matching invoices to cleared checks, posting entries and completing reconciliations. Other responsibilities included handling of discrepancies between Catamaran and individual pharmacies as well as prompt and correct reporting to 2 states.

ADDITIONAL EXPERIENCE

Preferred Healthcare Staffing

Payroll Specialist/Team Leader

Feb 2001- May 2003 Ft. Lauderdale, Florida

Input all new and re-hires into payroll system, including posting hours, housing, and bonuses while keeping all data updated and synced with ADP. Responsible for correctly transmitting between 250 and 500 employees’ multi-state payroll batches to ADP weekly. Also responsible for auditing and running various reports utilized by different department and divisional mangers for month-end closing.

Walgreens Pharmacy

Pharmacy Associate

Jan 1999 – Feb 2001 Coconut Creek, Florida

Patient Liaison responsible for entering new patients, insurance, and prescriptions into the system, as well as taking and receiving calls from patients, doctors and insurers. Also responsible for checking stock and maintaining the proper levels of inventory as well as filling prescriptions in queue.

ADDITIONAL PROFICIENCIES

Languages – Fully bilingual both spoken and written in English and Spanish

MS Office Suite Including Word, Excel, and PowerPoint

Communication skills

ADP Systems

Real Estate License 4+ years

Sales

Culture ambassador

CRMs

Work and collaborate well with others

VOLUNTEER

Miami Rescue Mission – Cover Girl

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