Customer Service Health Plan
Resume:
Tracie M Rainey
San Antonio, Texas 78249
ad2dx7@r.postjobfree.com
QUALIFICATIONS
A dedicated, well organized professional with a background
in customer service, office administration and sales.
Possess an excellent work ethic and a skilled organizer with
superb time management. An efficient worker who works with
minimum supervision.
EXPERIENCE
Wellmed Optum Care-Credentialing Coordinator Specialist
September 2021- Present
Work initial and re-creds credentialing all new providers.
Track and obtain demographic and contract documentation in a timely fashion, to include phone outreach to external customers.
Maintain and report on the Health Plan(s) compliance with contract submission rules and exception.
Support the contract submission process to ensure confirmation, provide support and ensure that appropriate internal controls are established to account for and secure hard copy or scanned images of contracts. (Emptoris, CAQH, NPPES, NSC, BC, DEA, Nurse System. PSV, SITE VISITS,PDF, PRAC local state license Credentialing rpt PDM status inquiry, Portico, OIG, DEA, Background check).
Maintain and update on a routine basis the contract organization’s databases.
Coordinate the data verification process for contracted providers.
Interface with the configuration, credentialing and provider data management staff to ensure all Health Plan data systems are congruent.
Specialist to ensure that medical staff members' maintain current credentials and licenses to work legally in their field or specialty.
Nationwide Insurance- Auto Claims Adjuster
February 2020- September 2021
● Handled auto claims, confirmed coverage, performed
field investigations and obtained recorded statements.
● Determined legal liability and negotiated settlements
for resolution of the claim.
● Secured lienholder payoff amounts, title acquisition
and rental billing.
SWBC, San Antonio, Texas - Commercial Collections
July 2018- December 2019
● Handled inbound/outbound calls to collect past due
payments.
● Used sound judgment with clients and corporate
policies to determine suitable collection solutions.
● Accurately investigated questions, problems or
complaints, with complex situations.
USAA, San Antonio, Texas - Client Service Associate
October 2008- October 2017
● Kept management systems up to date with client
information.
● Prepared reports and other documents for client
meetings.
● Handled and executed the transfer of funds with
external companies.
● Assisted with issuing Annuity policies, with face
value amounts of $20,000 to $5 million.
USAA, San Antonio, Texas — Life Insurance Underwriter
October 2006 - October 2008
● Evaluated and processed underwriting policies for the
status of pending life insurance applications.
● Researched medical records and obtained any medical
information as needed.
● Made final underwriting decisions for policies with
face amounts of $100,000 to $3 million dollars.
USAA, San Antonio, Texas - Manage Workload Supervisor
October 2004- October 2006
● Responsible for assigning the auto total loss
assignments for the U.S. regions.
● Provided support and direction for any rental issues
to include resolving issues, problems or complaints.
● Performed support tasks, including schedules, staffing
and workload data to the total loss departments.
Managed a team of 15 individuals.
USAA, San Antonio, Texas - Auto Claims Adjuster
March 1999 - October 2004
● Handled auto claims, confirmed coverage, performed
field investigations and obtained recorded statements.
● Determined legal liability and negotiated settlements
for resolution of the claim.
● Secured lienholder payoff amounts, title acquisition
and rental billing.
EDUCATION
University of Texas at San Antonio — Bachelor of Business
Administration Degree in Marketing, 1997
Contact this candidate