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United Healthcare - Senior Clinical Administrative Coordinator Resume Example

Oliver Martinez
XXXX XXXXXX XX, Mount Vernon, OH 43050
Ph: XXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXX
Summary

Seasoned healthcare Professional with more than 13 years of experience in fast-paced customer service oriented environment. Excellent Claims and benefits skills. Track record of achieving exceptional results in production and metric oriented goals.

Skills
  • Customer and Personal Service
  • Claims
  • Benefits
  • Insurance
  • Time Management
  • Administration and Management
  • Production and Processing
Experience
Senior Clinical Administrative Coordinator Apr 2015Present United Healthcare Westerville, Oh
  • Use computers for various applications, such as database management or word processing.
  • Perform payroll functions, such as maintaining timekeeping information and processing and submitting payroll.
  • Answer telephones and give information to callers, take messages, or transfer calls to appropriate individuals.
  • Set up and manage paper or electronic filing systems, recording information, updating paperwork, or maintaining documents, such as attendance records, correspondence, or other material.
  • Operate office equipment, such as fax machines, copiers, or phone systems and arrange for repairs when equipment malfunctions.
  • Schedule and confirm appointments for clients, customers, or supervisors.
  • Coordinate conferences, meetings, or special events, such as luncheons or graduation ceremonies.
  • Compose, type, and distribute meeting notes, routine correspondence, or reports, such as presentations or expense, statistical, or monthly reports.
  • Manage projects or contribute to committee or team work.
  • Order and dispense supplies.
  • Train and assist staff with computer usage.
  • Maintain updated client records with plans, notes, appropriate forms, or related information.
  • Identify the particular health care needs of individuals in a community or target area.
  • Advise clients or community groups on issues related to self-care, such as diabetes management.
  • Identify or contact members of high-risk or otherwise targeted groups, such as members of minority populations, low-income populations, or pregnant women.
  • Contact clients in person, by phone, or in writing to ensure they have completed required or recommended actions.
  • Advocate for individual or community health needs with government agencies or health service providers.
  • Collect information from individuals to compile vital statistics about the general health of community members.
  • Assist families to apply for social services, including Medicaid or Women, Infants, and Children (WIC).
Senior Credentialing Specialist Jan 2012Apr 2015 United Health Group Westerville, OH
  • Inbound call volume dealing with initializing the re-credentialing processes Working with network management to load provider contracts for Commercial and Community and State products. Keeping provider credentials compliant using CAQH Review and loading.   Provider profile for accuracy and eligibility for participation.  Setting up Site visits Advising providers on nuances of applications.  Demographic loading.
  • Create, maintain, and enter information into databases.
  • Set up and manage paper or electronic filing systems, recording information, updating paperwork, or maintaining documents, such as attendance records, correspondence, or other material.
  • Operate office equipment, such as fax machines, copiers, or phone systems and arrange for repairs when equipment malfunctions.
Senior Service Consultant Jan 2011Jan 2012 Morgan Stanley Columbus, Oh
  • Incoming calls for online technical support of MSSB website.
  • Resource in regards to conversion of Morgan Stanley to Morgan Stanley Smith Barney.
  • Allocating escalated issue's to level II technical consultants and then following up and resolving with clients.
  • Handling of special credit card programs to our Reserved clients worth over $1 million dollars.
  • Answer telephones and give information to callers, take messages, or transfer calls to appropriate individuals.
  • Develop or maintain internal or external company Web sites.
Benefits Consultant Jan 2008Jan 2011 Aetna New Albany, Oh
  • Drafting of Benefits Booklets, Summary of Benefits, and all Extraterritorial legislation for Mid America Regions.
  • Updating and renewing of all Benefit documents for over 30 companies; including but not limited to Customer specific benefits and Health Care reform.
  • Working with Account Mangers and Sales to review and set up all information pertaining to all Medical, Dental, and Pharmacy benefits.
Senior Customer Service Representative Jan 2003Jan 2008 Aetna New Albany, Oh
  • Answering 100 + inbound queue calls per day involving benefits, claims, payment, provider credentialing, complaints and appeals and overpay Training of new classes in regards to our Outbound Correspondence systems, In house Imaging systems, and Provider website helpdesk Focal for Provider website, answering escalated issues for Customer Services representatives to assist Medical providers and facilities with usage of the Aetna Web Routing of all correspondence to appropriate areas Network Escalation; resolving issues for Network representative for sensitive customers.
  • Projects involving 10 + Claims Assistance with call management, watching queue times, coaching on call time, scheduling days off and unplanned PTO Escalated mailbox handling sensitive customer and problem solving involving contracts, fee schedules and claims payments for Senior Network Management.
Education
Diploma Jan 1997 Arroyo Grande High School Arroyo Grande, CA Currently enrolled with the University of Phoenix. Focusing on an Associates degree with a concentration in Healthcare Administration. 3.0 GPA, qualified for an academic scholarship in 2015 for third quarter due to maintained GPA of 3.0 or above. Target date for graduation 05/2016.
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Resume Details

This is a real resume for a Senior Clinical Administrative Coordinator in Mount Vernon, Ohio with experience working for such companies as United Healthcare, United Health Group, Morgan Stanley. This is one of the hundreds of Senior Clinical Administrative Coordinator resumes available on our site for free. Use these resumes as templates to get help creating the best Senior Clinical Administrative Coordinator resume.

Previous Companies:

  • United Healthcare
  • United Health Group
  • Morgan Stanley

Previous Job Positions:

  • Senior Clinical Administrative Coordinator
  • Senior Credentialing Specialist
  • Senior Service Consultant
  • Benefits Consultant
  • Senior Customer Service Representative

Schools:

  • Arroyo Grande High School

Level of Education:

  • Diploma

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