Customer Care Specialist with Healthcare Focus
Resume:
SUZANNE M. McELYEA
**************@***.***
CAREER OBJECTIVE
Seeking responsible position that offers long-term employment, encourages initiative and presents opportunities for career advancement.
EXPERIENCE
4/2015 – 5/2025 United Healthcare P2P Support Team
Specialist
Take inbound calls from providers requesting a Peer-to-Peer discussion and determine optimal handling of the request based on line of business, review type, and other variables.
Prep requests for Peer-to-Peer discussions with Medical Directors and assign them in the appropriate medical management software.
Schedule calls between Providers and Medical Directors and maintain MD Outlook calendars.
Serve as P2P subject matter resource to team members, supervisors, and management staff.
Work with others as part of a team.
Cooperate with medical and admin staff to ensure compliance with standards and regulations.
Resolve operational issues using defined processes, expertise, and judgment.
Use knowledge and judgment to escalate complex problems to supervisor when necessary.
1/2009-4/2015 United Healthcare Intake Coordinator - Commercial/M&R
Respond to incoming provider and enrollee calls.
Resolve customer service inquiries which could include: Enter notifications, Providers status of an existing notification and determining if notification is required.
Complete notification wizard along with ICD-9 and CPT coding.
Provide excellent customer service to both providers and enrollees.
Constantly meet established productivity, schedule adherence, and quality standards while maintaining good attendance.
Assist with faxes and emails
Moderate work experience within own function.
Some work is completed without established procedures.
Basic tasks are completed without review by others.
Supervision/guidance is required for higher level tasks.
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