Thomas Gregorcy

Dallas, TX *****

ad4eui@r.postjobfree.com

+1-214-***-****

A dedicated, customer-focused medical professional with over 8 years of experience in healthcare management, seeking to leverage extensive background in Medicaid, Medicare, and managed care plans as a Medical Care Coordinator. Well-versed in medical claims processing, case management, and excels in utilizing advanced Excel skills for data analysis and reporting. Proficient in ICD 10, medical terminology, triage, intake, care planning, and coordination. Aiming to contribute my expertise to improve client satisfaction and operational efficiency in a dynamic healthcare setting. Work Experience

FSS Coordinator

Dallas Housing Authority - Dallas, TX

June 2023 to December 2023

• Created action plans with short-term and long-term goals with the client.

• Monitored the client’s progress by maintaining contact, making referrals and calculations, providing workshops and educational opportunities, and updating the client's needs.

• Entered information into the computer system to record client progress in the care plan and goals every quarter.

• Interviewed clients by telephone or face to face; located resources and services.

• Followed up on resources and services referred. I acted as a liaison between the client and community resources.

• Utilized motivational interviewing and coaching to assist clients in finding employment and educational advancement opportunities.

• Completed need assessments, reviewed program requirements, and answered questions about the programs available.

• Created care plans with short-term and long-term goals

• Completed monthly reports and compiled statistical data. Medical Services Case Coordinator

Molina Healthcare Inc - Long Beach, CA

June 2022 to May 2023

• Conducted direct outreach to new Medicare members, providing personal assistance with MAPD, DSNP, and MMP plans with triage, intake, risk assessment, and care planning.

• Reviewed program requirements with clients, addressing inquiries and guiding clients through available program options to meet their needs.

• assisted Case Manager and Social Workers through contact with Members for assigned cases in scheduling appointments, arranging transportation, obtaining records, and documenting case management activities in the case management software program.

• Generated monthly reports and compiled statistical data to evaluate program effectiveness and client outcomes.

• Conducted direct outreach to new Medicare members, providing personalized assistance with various plans and coordinating care planning efforts.

• Facilitated the enrollment of members in patient assistance programs, coordinated medical appointments, and managed the assignment of medical case managers.

• Played a pivotal role in documenting progress in online medical records and revising care plans to set new goals, ensuring alignment with members' evolving needs.

• Demonstrated expertise in utilizing healthcare and CRM software for medical record review, retro authorizations, DME orders, and securing prior authorizations.

• Delivered exceptional service via email, chat, and text, addressing requests and providing detailed explanations of plan benefits and community resources. HR Benefits Agent Fully Remote

Alight Solutions - Miami Beach, FL

March 2021 to June 2022

• Handled high-volume of phone calls, emails and correspondence from clients’ employees to answer questions, provide education, and solve complex HR and financial issues related to their health care benefits, 401k savings and retirement plans, leaves of absence, payroll, etc.

• Assisted with fund transfers, withdrawals, and Loans on 401K accounts.

• Worked on escalated Consumer Relations cases using Zendesk and CRM and negotiated Self Directed Healthcare appeals with healthcare providers.

• Provided basic navigation help and troubleshooting of web and phone applications.

• Support with full cycle associate onboarding and offboarding processes. Senior Behavioral Health Customer Advocate Remote

BCBSTX - Richardson, TX

October 2019 to March 2021

· Provided advocate care to assist the member with a clear path to care, claims understanding and resolution and educates the member with online resources.

· Guided the members through their medical plan of benefits, BCBS policy and procedures.

· Assisted with troubleshooting basic web issues. Performed financial data maintenance as necessary and explained member's rights and responsibilities in accordance with the contract.

· Assisted Member in locating professional care.

· Took escalated calls and processed root cause analysis. Long Term Care Agent

Transamerica Life Insurance Company - Plano, TX

August 2015 to September 2019

· Specialized in addressing in-bound inquiries related to long-term care insurance policies, including detailed explanations of coverage benefits, billing methods, and underwriting requirements, enhancing customer understanding and satisfaction.

· Guided policyholders through plan change procedures, account reconciliation, and reinstatement processes, ensuring a seamless experience during critical transitions.

· Updated policyholder account information upon request, ensuring accuracy and up-to-date records, which facilitated personalized and efficient customer service.

· Maintained meticulous documentation of all customer interactions, ensuring each phone call detail was accurately captured for continuous service improvement and compliance with policyholder communication standards.

· Ensured strict adherence to HIPAA guidelines and company policies regarding customer confidentiality, establishing a secure and trust-based environment for policyholders. Customer Retention Agent

ADT Security Company - Irving, TX

June 2014 to August 2015

· Saved customers by tailoring offers to their needs.

· Handled escalated calls from customer service and saved customers from canceling their security service.

Benefit Customer Service Agent

Mercer Human Resource Consulting - Dallas, TX

March 2013 to March 2014

· Handled over 110 inbound calls assisting employees with employer benefit questions.

· Assisted with open enrollment with benefit presentations and the distribution of enrollment Information.

· Assisted employees with questions pertaining to their pension plan.

· Assisted with website navigation and general troubleshooting.

· Peoplesoft, HRIS and Workday.

Client Service Agent

PFSWEB - Dallas, TX

April 2012 to February 2013

· Responded to tickets, chats or email relating orders for three online luxury brand stores.

· Worked with vendors and clients to resolve any escalated concerns.

· Resolved Tier 1 technical tickets.

· Assisted customer service agents with follow-up and research on complex issues.

· Jira, Salesforce and Zendesk.

Executive Customer Relations Agent

Wingspan Portfolio Advisors LLC

May 2010 to February 2011

· Handled all executive and regulatory complaints forwarded to the Office of the President for the largest mortgage company in America.

· Worked escalated requests for loan modifications and Short Sales.

· While on the job I obtained expert knowledge of the Real Estate Settlement

· Procedures Act, Truth and Lending Laws and available loss mitigation programs. ·

· Completed root cause analysis and recommended policy and procedure changes. Loss Mitigation Agent

Bank of America - Richardson, TX

November 2007 to July 2009

· Contacted and interacted with delinquent borrowers to review different options to pay delinquent mortgage payments and prevent foreclosure.

· Enforce loan workouts, forbearance, stipulations, modifications as well as deed in lieu transactions adhering to investor guidelines.

· Supervised all forbearance, changes and payment plans to ensure compliance to agreements. · Expert knowledge of Short Sales, Loan Modifications, Deed in Liu processes and government programs.

· I assisted customers to process loan modifications and Short Sales through Salesforce and Fiserv.

· Knowledge of FHA, VA, and USDA loss mitigation guidelines. Knowledge of FNMA and FHLMC loss mitigation guidelines.

· Proficient in the use of Microsoft Office applications specifically Excel, Word, and Outlook.

· Proficient in calculating income, debt owed, loan to value ratios, & debt to income and REO procedures. Collections Representative

Nissan - Irving, TX

June 2005 to September 2007

· Answered inbound and made outbound collections calls. · Setup payment arrangements and took payments for past due car loans.

· Expert knowledge of The Fair Debt Collection Practices Act (FDCPA)

· Proficient with Zendesk, other CRM Platforms and Salesforce.

· Proficient with Microsoft Office Products and NetSuite.

· Working knowledge of SAP.

· HRIS and Workday

Education

Bachelor of Arts in Human Services

Ottawa University - Ottawa, KS

January 2010 to December 2014

Skills

• Salesforce

• CRM software

• Account management

• Customer relationship management

• Customer service

• Presentation skills

• Live chat

• Google Suite

• Zendesk

• Sales

• Banking

• SharePoint

• Financial services

• Typing

• Conflict management

• Workday

• PeopleSoft

• Ceridian

• HubSpot

• HIPAA

• Research

• Microsoft Excel

• Customer support

• EHR systems

• English

• ICD-10

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