Sales Customer Service
Resume:
JEROME C. CHAMBERS
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Summary
MBA graduate with 10 years of relevant Health Care experience in for-profit and not-for-profit Managed Care Organizations. Specific health insurance experience servicing (Commercial) Individual Market/ Group Market/ Medicare Advantage/ Medicaid/ D-SNP/ (MyCare Ohio) integrated lines of business. Also Certified Revenue Cycle Representative (CRCR). Experience and expertise includes: enterprise strategic solutions, network management, network operations, health plan operations, start-up implementation, new market builds, contract negotiations, developing key strategic partnerships, sales, marketing, and research. EXPERIENCE
MARCH 2019 – PRESENT
REVENUE RECOVERY REPRESENTATIVE, ENSEMBLE HEALTH PARTNERS
• CLIENT: MERCY HEALTH HOSPITAL SYSTEM
• BECAME VERY FAMILIAR WITH PAYER CONTRACTS (COMMERCIAL, MEDICARE AND MEDICAID) FOR TECHNICAL CLAIM UNDERPAYMENTS
• SUBMITTED RECONSIDERATIONS TO OBTAIN UNDERPAID INPATIENT AND OUTPATIENT CLAIMS
• EXAMINE DENIED AND UNDERPAID CLAIMS TO DETERMINE THE REASON FOR DISCREPANCIES
• IDENTIFIED SEVERAL SYSTEM AND PROCESS TRENDS AND ADDRESSED THE ROOT CAUSES OF THE ISSUES
SEPTEMBER 2018 – MARCH 2019
HEALTH PLAN ADVISOR, ANTHEM CONTRACTOR
• Primary contact in handling routine and complex policy holders inquiries, regarding authorization, benefits, claims, and general assistance.
• Successfully executed quality customer service through fast responsiveness, reliability, assurance, and professionalism
• Utilize problem resolution and negotiating skills to deescalate any irate customers
• Assist members by enhancing their current plans with supplemental benefits for increased sales
2
JULY 2017 – PRESENT (PART-TIME SALES AGENT)
INDEPENDENT MEDICARE AGENT, UNITED HEALTHCARE
• Developed sales presentations to a large number of clients every month, with a high conversion ratio
• Provided one-one- services to clients to meet their healthcare goals through customized packaging
• Achieved a 97% retention rate
• Maintained compliance with state and federal regulations
• Research market/identifying leads, prepares marketing plans APRIL 2014 – MAY 2017
NETWORK CONTRACT SPECIALIST, AETNA
• Manage, developed, and maintained providers’ network in 6 Southwest Ohio Counties Montgomery, Greene, Clark, Warren, Butler, Hamilton
• Company representative in community outreach/forums, provider training/seminar/ conferences, and government forums
• Managed external contracting activities and coordinate internal contracting processes including credentialing and provider loading to claims systems
• Negotiated rates and language for provider agreements and single case agreements for in and out-of-network providers
• Performed analysis on payment and utilization data to renegotiate financially viable contracts with high utilization facilities and control medical cost trends
• Mentored new provider department staff in network strategic planning and contracting SEPTEMBER 2007 – APRIL 2014
GROUP & INDIVIDUAL ACA AGENT (8 MONTHS), CARESOURCE
• Conducted sales presentations to a large number of clients monthly with a 50% conversion ratio
• Company representative in community outreach events and conferences
• Made calls (phone and in person) to small business owners to set appointments for face- to-face meetings
MARKETING SPECIALIST (1 YEAR – 3 MONTHS), CARESOURCE
• Drafted and designed company sales and marketing materials
• Participated in comprehensive forums to increase the website presence and utilization
• Collected data of potential customers for different projects
• Researched and prepared briefings on sales prospects AGENT BROKER MANAGER (1 YEARS – 2 MONTHS), CARESOURCE
• Recruited, trained, and managed 33 Medicare Independent Agents
• Developed a broker agent compliance, training, and contracting process manual
• Developed sales and marketing strategies to exceeded annual sales goals
• Developed and Conducted quarterly agent ride-along and corporate training 3
• Ensured commissions were paid accurately and timely MEDICARE ACCOUNT MANAGER (3 YEARS – 5 MONTHS), CARESOURCE
• Set up and implement marketing plans
• Established a referral system by creating a customer service follow up program
• Trained new account managers, brokers and new hires in other departments
• Developed a grass root marketing strategies for the Dual Medicare Advantage product
(Initially 17 Ohio counties)
• Increased the plan growth managing the broker relationships (33) and oversight in Ohio and Michigan
• Developed relationships with external stakeholders in the public housing sector, providers and community agencies
EDUCATION
APRIL 2012
MBA, INDIANA WESLEYAN UNIVERSITY
Concentration: Healthcare Administration
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