Operations & Client Services Professional

PROFESSIONAL SUMMARY

SKILLS

EXPERIENCE

KEVIN SPEARS JR.

315-***-**** ****************@*****.*** Syracuse, NY 13208 To obtain a position in an organization which promotes career advancement. 15+ years of white glove customer service experience. Proficient use of Microsoft Suite. Outstanding written and oral communication. Hardworking, highly motivated professional eager to lend combined knowledge and skills to enhance business performance. Operates well in both individual and team capacities, leveraging seasoned work ethic to quickly adapt to different processes and drive company objectives. Resourceful and results-driven with a passion for growth and efficiency to meet company needs and increase service value.

Conflict management Team building

Excellent Communication Time Management

Critical Thinking Ability To Multitask

Data Analysis Provider Relationship Management

Workflow Analysis Health Plan Operations

Customer Satisfaction Claims Reviewing

Business Correspondence Medical Billing and Coding Healthcare Terminology Educational Presentations

Billing Issue Resolution and Support Investigate Complaints Fidelis Care

Syracuse, NY October 2022 - August 2025

Conduct on-site provider orientations, encompassing the development and maintenance of orientation materials, facilitating the acclimation of providers to the plan website. Monitor and analyze the financial performance of contracts, ensuring alignment with established objectives and goals. Investigate and meticulously document provider changes and correspondence, maintaining accurate records of all interactions. Collaborate with credentialing teams to ensure the reception of comprehensive documentation, fostering a streamlined and efficient process. Take the lead on key special projects, demonstrating organizational and leadership skills to achieve project objectives successfully. Offer recommendations for changes in pricing subsystems, contributing to strategic decision-making processes. Coordinate the printing of provider directories in collaboration with corporate and plan-level entities, ensuring accuracy and timely distribution. Investigate and respond adeptly to complex provider-related issues, initiating necessary changes in provider-related database information. Serve as a subject matter expert for provider relations activities, providing valuable insights and acting as a mentor for Provider Relations Specialist I staff. PROVIDER ENGAGEMENT ACCOUNT EXECUTIVE

United Healthcare

Syracuse, NEW YORK December 2020 - October 2022

Providing expertise, advocacy, and comprehensive service support to members and their families. Responsible for direct phone-based and email consumer interaction to address complex member needs. Provide recommendations on services that help close gaps in care for members. Adjusting and reprocessing medical claims that have been denied for reasons such as subrogation and accident details, coordination of benefits updates, and medical necessity HEALTH PLAN ADVISOR

EDUCATION

requests. Addressing complex questions, and effectively referring care for medical, dental, flex, pharmacy benefits, eligibility and claims, financial spending accounts and correspondence. United Healthcare

Syracuse, NEW YORK March 2019 - December 2020

Providing support to members and providers in regards to medical benefits and medical claims. Processing, adjusting, reviewing, and researching healthcare claims from members and providers by navigating multiple computer systems and platforms. Verifying the data/information necessary for processing (e.g. pricing, prior authorizations, applicable benefits) are valid. Ensuring that the proper benefits are applied to each claim by using the appropriate processes and procedures (e.g. claims processing policies and procedures, grievance procedures, state mandates, Medicare guidelines, benefit plan documents/certificates) are followed so that each party is billed and paid correctly. CLAIM SPECIALIST

PADCARE INC

East Syracuse, NY February 2016 - September 2017

Completing tickets submitted by CSR's, which vary from taking escalated calls to providing technical support for customers' online accounts. Answering agent inquires directly. Processing Primary Contact Transfer Forms and Enrollment Forms.

BUSINESS OFFICE / TICKET TEAM SPECIALIST

PADCARE INC

East Syracuse, NY October 2015 - February 2016

Managing agents and supervisors located in the call center. Answering agents' inquires. Providing technical support directly for agents. Delegating tasks and roles to the supervisors. Assigning agent shifts and break schedules. Taking calls that have escalated beyond the level of an agent. OPERATIONS MANAGER

PADCARE INC

East Syracuse, NY May 2008 - September 2015

Answering inbound calls for Merck Animal Health Home Again Pet Recovery Service in regards to updating customer contact information and taking payments, reporting customers' pets missing and issuing lost pet alerts to participating vet, clinics, shelters, and individuals signed up as pet rescuers in the area in which their pet went missing. CUSTOMER SERVICE REPRESENTATIVE

Orange High School, Orange, NEW JERSEY June 2004

HIGH SCHOOL DIPLOMA

Hudson Valley Community College, Troy, NEW YORK May 2003 RADIOLOGIC TECHNOLOGY IN RADIOLOGIC TECHNOLOGY

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