Summary
Overview
Work History
Education
Skills
Additional Information
Timeline
Generic

CHARLES J. SIMS

Summary

Seeking challenging opportunities to apply skills, abilities and experience in Management, Sales, Marketing, Customer Service and/or Public Relations. QUALIFICATIONS SUMMARY Significant experience promoting and selling intangible services and company mission. Accomplish direct sales and marketing of tangible and intangible products. Build client base through assertive cold calling, prospecting and referral networks. Create proactive marketing campaigns to expand awareness of products and services, attract business and maintain product loyalty. Generate, design and produce products ranging from newsletters to media releases. Provide recommendations and guidance to management on problem mitigation and resolution for community, public and media relations. Apply innovative solutions to complex problems by identifying root cause of difficulties. Administer customer relations functions; respond to questions, problems, complaints promptly and efficiently. Utilize strong written and oral communications skills. Quickly establish and maintain effective rapport with individuals of diverse backgrounds. Apply well developed time management skills to define priorities and implement activities tailored to meet deadlines. Handle multiple tasks successfully. Self motivated professional with a reputation for reliability, profitability, efficiency and effectiveness in detail-oriented environments. Safety-conscious School Bus Driver in school bus transportation work and high regard for student safety. Transported large school district's students on daily routes and field trips and earned high safety ratings every year. Excellent driving and communications skills leading to outstanding results.

Overview

35
35
years of professional experience

Work History

School Bus Driver

Henrico County Public Schools
10.2022 - Current
  • Enhanced student safety by strictly adhering to bus routes and schedules, as well as enforcing established behavior guidelines.
  • Reduced vehicle maintenance costs by conducting daily pre-trip inspections and promptly reporting any necessary repairs or concerns.
  • Improved on-time performance with efficient route planning, taking into consideration traffic patterns and weather conditions.
  • Provided a positive environment for students during transportation, fostering respectful interactions and promoting good behavior.

Sr. Network Account Manager

United HealthCare of Nevada
04.2014 - 07.2019
  • UnitedHealthcare Network Lead for State of Nevada Commercial & Tricare products
  • Manage relationship with portfolio of physicians
  • Facilitate financial analysis of all reimbursement rate proposals
  • Determine network adequacy and recruit new providers
  • Identify provider education opportunities and deliver appropriate training
  • Participate in fraud and abuse investigations
  • Create general communications pieces for network.

Sr. Provider Relations Advocate

United HealthCare of Virginia
01.2010 - 01.2014
  • Responsible for full range of provider relations and service interactions within UnitedHealth Group, including working on end-to-end provider claim and call quality, training physician groups on use of UHC web portal and future service enhancements
  • Also presenting training materials, Rebranding, Id Cards, Quick Reference Guides, UHC Voice Portal, Network Bulletin, Physician Data Quality, Immunizations, HIPPA 5010/ICD 10 Prep, and Product Guide
  • Reviewed gaps in network composition and services to assist network contracting and development staff in prioritizing contracting needs
  • Assisted various departments with change by communicating new improvement plans and expectations
  • Boosted customer experiences by delivering superior customer service, issue resolution and merchandising
  • Evaluated performance and policies against metrics.

Network Account Manager

United HealthCare of Virginia
01.1998 - 01.2010
  • Manage relationship with portfolio of physicians
  • Facilitate financial analysis of all reimbursement rate proposals
  • Determine network adequacy and recruit new providers
  • Identify provider education opportunities and deliver appropriate training
  • Participate in fraud and abuse investigations
  • Create general communications pieces for network
  • Secured high-value accounts through consultative selling, effective customer solutions and promoting compelling business opportunities
  • Identified key entry points to enhance market penetration and effectively analyzed data to optimize customer satisfaction and increase profitability
  • Elevated account management by predicting potential competitive threats and outlining proactive solutions.

Provider Relations Supervisor

Chartered Health Plan of Virginia
01.1996 - 01.1998
  • Direct staff in daily activities involving physician and ancillary recruitment, the servicing of relationships, resolving problems, credentialing and re-credentialing providers and the negotiation of contracts
  • Coordinate office telecommunications and correspondence, maintain and distribute provider information, develop, revise and assure compliance with policies and procedures, and submit regular reports on the status of operations compared to budgets, goals and objectives
  • Developed, implemented, revised and evaluated policies and procedures
  • Developed improvement plans to solve problems and improve lagging areas.

Provider Relations Representative

The Prudential
01.1989 - 01.1996
  • Managed complaint resolution, reimbursement and recruitment for physician and ancillary network
  • Monitored and interpreted data relevant to provider's performance
  • Negotiate contracts with ancillary providers, analyzed financial utilization, quality factors and worked closely with regional contacts on project assignments
  • Investigated and corrected overpayments to providers above capitation limits saving tens of thousands of dollars annually
  • Saved $22,000 through negotiation of services with ancillary providers since 06/95
  • Recruited about 100 new primary care physicians annually
  • Served as Customer Service Representative delivering information on services to members, prospective members and employers
  • Previous positions included Claim Service Representative and Technical Advisor.

Education

University Of Richmond - Richmond, VA. -

Faith Landmarks Bible Institute - Richmond, VA -

CDL Class A - Truck Driving

CDS Trucking
Richmond, VA
11.2023

Class B CDL - Student Transportation

Henrico County Public School System
Henrico, VA.
11.2022

Project Management Certification - Project Management

Google Project Management
San Francisco, CA
10.2022

Skills

  • Budgets
  • Contracts
  • Customer Service
  • Financial
  • Financial analysis
  • Office
  • Negotiation
  • Network
  • Quality
  • Recruitment
  • Telecommunications
  • Training materials
  • Web portal
  • Composition
  • Order management
  • Operations
  • Policies
  • Presenting
  • Proposals
  • New account creation
  • Cost reviewing

Additional Information

  • Church Activities
  • Aviation
  • Police Chaplain
  • Service Manager for 12,000 member church congregation in Richmond, Va. Assured various departments were staffed and operating for services. This included inside and outside security, Children's ministry, Ushers, Medical team, Pastor's Aides and other departments.
  • Served as Care Pastor performing hospital visits, prison ministry, responded to telephone calls in emergency situations.
  • Participated in "Ride Along" with Henrico PD, with Police Officer patrol shift.
  • Flown Cessna 172 as student and desire to obtain private pilot certification.

Timeline

School Bus Driver

Henrico County Public Schools
10.2022 - Current

Sr. Network Account Manager

United HealthCare of Nevada
04.2014 - 07.2019

Sr. Provider Relations Advocate

United HealthCare of Virginia
01.2010 - 01.2014

Network Account Manager

United HealthCare of Virginia
01.1998 - 01.2010

Provider Relations Supervisor

Chartered Health Plan of Virginia
01.1996 - 01.1998

Provider Relations Representative

The Prudential
01.1989 - 01.1996

University Of Richmond - Richmond, VA. -

Faith Landmarks Bible Institute - Richmond, VA -

CDL Class A - Truck Driving

CDS Trucking

Class B CDL - Student Transportation

Henrico County Public School System

Project Management Certification - Project Management

Google Project Management
CHARLES J. SIMS