**** ******** ** *****

Plant City, FL *****

Contact: 813-***-****

Email:

Frances Martin

Summary of Qualifications

• Seasoned health care professional, 30 years’ experience with healthcare products inclusive of; HMO, ASO, Fully Insured, Indemnity Accounts, Disability and Mental Health, inclusive of Employer Individual, Medicare & Retirement, Community and State (Medicaid)

• Results-oriented, decisive leader with proven success in strategic thinking and problem solving

• Ability to think strategically in high-pressure situations, melding good business and technical decisions with bottom line focus.

• Strong interpersonal skills, ability to work in a matrix environment, excellent verbal and written skills, confident in presenting information to all levels of the organization, excellent follow through, ability to set clear direction and vision for the organization, ability to understand complex issues and drive action to achieve results

• Consistently successful in dynamic, fluid environments while remaining practical and focused

• Excellent multi-tasking and organizational aptitudes

Computer Literacy

Microsoft Tools Applications: Outlook, Scheduler, Explorer, Word, Excel, PowerPoint, Access, Visio, MS Teams. Reporting Tools/Systems: Crystal, SAM and Cognos/Orbit, ITSM ServiceNow, Peoplesoft

Work Experience

2008 - Present United Health Group

Provider Claims Resolution Specialist

• Facilitate service issue resolution through action planning with appropriate areas. Respond to and resolve escalated claim and non-claim issues with customers. This includes verbal and written communication.

• Manage escalated issues and respond to legislative complaints and grievance. This includes concerns received from Departments of Insurance, Revenue, Justice and Finance, Attorney General, and congressional complaints.

• Provide leadership in the communication and resolution of problems and issues to our customer.

• Support the overall delivery of the benefits and services by providing support and guidance to existing and potential customers.

• Proactive approach to identifying and resolving global trends and issues.

• Drive process improvement based on trend analysis.

• Manage escalated issues and respond to inquiries.

• Investigate claim and customer service issues as identified and communicate resolution to customers.

• Proactively identify and resolve global trends and issues.

• Provide feedback to customer service and claim staff regarding improvement opportunities.

• Investigate and facilitate service issue resolution through action planning with appropriate areas.

• Participate in department projects that impact communication to members.

2005-2008 United Health Group

TRS Specialist- Uniprise Operations

• Perform both simple and complex claim adjustments on all claim types.

• Make outbound phone calls to clients to fully resolve adjustments/issues.

• Supporting training department in house as an OJT (On the Job) mentor for queue processing.

• Support Uniprise international training initiatives by traveling to the Wipro Spectramind Services Pvt Ltd. office in Mumbai, India and performing OJT (On the Job) mentoring for their Transaction Resolution Specialist classes for two months (2007).

2004 – 2005 Inpatient/High Dollar Telecommuter Claims Specialist

• Telecommuting as an inpatient/high dollar claims specialist in support of the Oldsmar, Fl Service Center with responsibilities shifting to the Oldsmar office.

• Supporting training department in house as an OJT (On the Job) mentor for queue processing.

2001-2004 Telecommuter Claims Specialist

• Telecommuting as a claims specialist from 2001 to 2004 in support of the Albany, New York Service Center with responsibilities shifting to the Oldsmar office with the close the Albany office and the redistribution of work.

• Supporting training department in house as an OJT (On the Job) mentor for queue processing.

1999-2008 United Health Group

Call Center Supervisor

1998-1999 United Health Group

Service Center Representative

1997-1998 United Health Group

Service Center Associate

1992-1997 Blue Shield of Northeastern N.Y.

Priority Service Specialist

1988-1992 Blue Shield of Northeastern N.Y.

Claims Examiner

Education

2002 – Present Hillsborough Community College Business Adm in Applied Science

1999 – 2001 Hudson Valley Community College – Business Administration in Applied Science

1985 – 1986 Hudson Valley Community College – Early Childhood Education

1983 – 1984 Maria College - Early Childhood Education

• References are available upon request

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