Summary
Overview
Work History
Education
Skills
Software
Certification
Timeline
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Craig Vernon

Craig Vernon

Health Insurance
St. Petersburg,FL

Summary

Compassionate Patient Navigator with a distinguished understanding of insurance processes and medical billing. Adept at patient and family education and paying attention to details. Successful at building relationships with clients. Effective Medical Claims Processor with strong background building rapport with providers to discuss claim status or claim denials. Driven performer equipped to handle multiple administrative tasks effectively. Exemplary worker with highly investigative skills when processing claims. Energetic Supervisor successful at motivating and building positive team dynamics to accomplish aggressive goals. Dedicated to open, communicative culture where employees feel empowered to contribute to company's success. Accomplished Supervisor focused on meeting customer expectations and achieving company goals. Drives success by directing high-producing teams while developing lasting employee rapport. Exceptional knowledge of cost-reduction methods and streamlining production processes. Passionate about promoting lasting customer satisfaction by delivering quality service and unparalleled support. Proficient in customer service best practices and related options.

Overview

40
40
years of professional experience
4
4
years of post-secondary education
1
1
Certification

Work History

Patient Navigator

United Healthcare
Saint Petersburg, Florida
02.2023 - Current
  • Educated patients on insurance and healthcare plans.
  • Identified barriers when treatment goals not met, treatment plan not followed or important appointments missed and collaborated in redeveloping patient treatment goals.
  • Assisted patients in scheduling doctor and healthcare appointments.
  • Consulted with medical staff and ancillary department to eliminate barriers to delivery of care and identified service delivery problems and potential for patient management intervention.
  • Organized patient schedules and assisted in planning transportation and payments.
  • Assisted with and facilitated transition of care from hospitals, rehabilitation facilities and skilled nursing facilities to home.
  • Participated in regular team meetings, huddles, staff meetings and quality improvement projects to improve patient care.
  • Coached patients on self-advocacy.
  • Verified patient insurance eligibility and entered patient information into system.
  • Resolved customer complaints using established follow-up procedures.
  • Provided excellent customer service to patients and medical staff.

Customer Service Associate

United Healthcare
Saint Petersburg , Florida
04.2022 - 02.2023
  • Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
  • Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
  • Responded to customer calls and emails to answer questions about products and services.
  • Informed customers about special promotions and provided detailed information for various products.

Supervisor

Buckeye All Stars
Delaware, OH
01.2013 - 04.2022
  • Applied strong leadership talents and problem-solving skills to maintain team efficiency and organize workflows.
  • Handled customer complaints, resolved issues, and adjusted policies to meet changing needs.
  • Enforced rules and regulations outlined in company manual to set forth expectations comprehensibly and consistently.
  • Mentored newly hired employees on operating equipment and safety and developed training manual to use for reference.

Customer Service Representative

Verizon Wireless
Hilliard, OH
05.1995 - 01.2013
  • Answered customer telephone calls promptly to avoid on-hold wait times.
  • Responded to customer requests for products, services, and company information.
  • Updated account information to maintain customer records.
  • Provided primary customer support to internal and external customers.

Claims Trainer

Equitable Life Insurance
Delaware, OH
04.1989 - 05.1995
  • Consulted with various business unit leaders, keeping pulse on business to identify training needs and coordinate learning solutions.
  • Collected and analyzed data to determine ROI or ROE, contributing to evaluation of training courses and program effectiveness.
  • Assimilated information and complex technical concepts when preparing to facilitate new and updated courses.
  • Modeled ethical behavior and executed job responsibilities in accordance with company core values, ethics and information protection policies.

Supervisor, Health Claims

Equitable Life Insurance
Delaware, OH
06.1986 - 04.1989
  • Paid or denied medical claims based upon established claims processing criteria.
  • Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
  • Handled customer complaints, resolved issues, and adjusted policies to meet changing needs.
  • Maintained clean and well-organized production areas to avoid violations or unnecessary work delays due to hazards or inefficient layouts.
  • Enforced rules and regulations outlined in company manual to set forth expectations comprehensibly and consistently.
  • Applied strong leadership talents and problem-solving skills to maintain team efficiency and organize workflows.
  • Mentored newly hired employees on operating equipment and safety and developed training manual to use for reference.
  • Achieved results by working with staff to meet established targets.
  • Evaluated employee performance and coached and trained to improve weak areas.

Medical Claims Examiner

Equitable Life Insurance
Delaware, OH
06.1983 - 06.1986
  • Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
  • Used administrative guidelines as resource or to answer questions when processing medical claims.
  • Responded to correspondence from insurance companies.
  • Paid or denied medical claims based upon established claims processing criteria.

Education

High School Diploma -

Rutherford B Hayes High School
Delaware, OH
09.1977 - 06.1981

No Degree - Business Management

Columbus State Community College
Columbus, OH
05.2001 -

Skills

Telephone etiquette

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Software

Microsoft Office

Certification

M&R Certified Professional

Timeline

Patient Navigator

United Healthcare
02.2023 - Current

M&R Certified Professional

08-2022

Customer Service Associate

United Healthcare
04.2022 - 02.2023

Supervisor

Buckeye All Stars
01.2013 - 04.2022

No Degree - Business Management

Columbus State Community College
05.2001 -

Customer Service Representative

Verizon Wireless
05.1995 - 01.2013

Claims Trainer

Equitable Life Insurance
04.1989 - 05.1995

Supervisor, Health Claims

Equitable Life Insurance
06.1986 - 04.1989

Medical Claims Examiner

Equitable Life Insurance
06.1983 - 06.1986

High School Diploma -

Rutherford B Hayes High School
09.1977 - 06.1981
Craig VernonHealth Insurance