Douglas Izenas
Monroeville,PA
Summary
Seasoned healthcare professional with over nine years of experience in business analysis, healthcare operations, and quality management, specializing in Coordination of Benefits (COB) and claims processing. Proven track record of leading teams, driving process improvements, and ensuring regulatory compliance to enhance operational efficiency and customer satisfaction. Adept at translating complex technical requirements into actionable business strategies, with strong analytical skills and expertise in Medicare, Medicaid, and commercial healthcare plans. Highly skilled in data analysis, project management, and stakeholder engagement, with a commitment to delivering high-quality outcomes and innovative solutions in the healthcare industry.
Overview
9
9
years of professional experience
Work History
Accumulator Adjuster III
UPMC Health Plan
05.2023 - Current
- Maintained strong relationships with policyholders, agents, and colleagues by consistently demonstrating professionalism, empathy, and effective communication skills.
- Ensured compliance with state regulations and company policies through diligent review of all claim-related materials.
- Streamlined workflow for faster claim resolution by coordinating with various internal departments and external agencies.
- Optimized data management processes by accurately documenting claim details in company systems for easy retrieval during audits or future inquiries.
Accumulator Adjustor II
UPMC Health Plan
05.2022 - 05.2023
- Proved successful working within tight deadlines and a fast-paced environment.
- Assisted with day-to-day operations, working efficiently and productively with all team members.
- Adaptable and proficient in learning new concepts quickly and efficiently.
- Demonstrated strong organizational and time management skills while managing multiple projects.
Technical Claims Specialist II
UPMC Health Plan
11.2020 - 05.2022
- Managed a high volume of claims effectively by prioritizing tasks and maintaining excellent organizational skills.
- Enhanced customer satisfaction with timely communication, empathy, and clear explanations of claim outcomes.
- Developed strong working relationships with external partners such as adjusters, legal counsel, and medical professionals to facilitate efficient claim resolution processes.
- Responded to inquiries by answering questions, providing information and directing customers to appropriate resources.
Coordination of Benefits Specialist III
UPMC Health Plan
09.2019 - 11.2020
- Reduced costs by identifying inefficiencies in operations and implementing cost-saving measures.
- Created and delivered presentations to internal and external stakeholders to showcase work.
- Conducted thorough research to identify trends and inform decision-making for business growth initiatives.
- Championed the adoption of new software tools that streamlined workflows across multiple departments.
Coordination of Benefits Specialist II
UPMC Health Plan
07.2018 - 08.2019
- Improved customer satisfaction rates through proactive problem-solving and efficient complaint resolution.
- Interpreted clients' needs and introduced services to fit specific requirements.
- Built and managed relationships with key clients and partners to drive growth.
- Oversaw daily operations of a busy office environment, ensuring tasks were completed efficiently and accurately.
- Generated reports detailing findings and recommendations.
Coordination of Benefits Specialist
UPMC Health Plan
10.2016 - 07.2018
- Followed all company policies and procedures to deliver quality work.
- Attended training programs to deepen professional skillset and assisted in training fellow store associates on existing and new training programs.
- Mentored junior team members, fostering professional growth through guidance on best practices in the industry.
Kitchen Manager
Chipotle
05.2015 - 10.2016
- Maintained a clean and safe work environment, adhering to all health department regulations and guidelines.
- Scheduled and received food and beverage deliveries, adhering to food cost and budget.
- Checked and tested foods to verify quality and temperature.
- Mentored and trained new team members, fostering a positive culture of teamwork and collaboration within the kitchen staff.
Education
MBA - Business Administration And Management
Youngstown State University
Youngstown, OH05.2024
Bachelor of Science - Agricultural Science
Pennsylvania State University
University Park, PA12.2014
Skills
- Requirements Gathering
- Data Analysis
- Project Management
- Business process improvement
- Quality Assurance
- Stakeholder Management
- Business Planning
- Forecasting and planning
Timeline
Accumulator Adjuster III
UPMC Health Plan
05.2023 - Current
Accumulator Adjustor II
UPMC Health Plan
05.2022 - 05.2023
Technical Claims Specialist II
UPMC Health Plan
11.2020 - 05.2022
Coordination of Benefits Specialist III
UPMC Health Plan
09.2019 - 11.2020
Coordination of Benefits Specialist II
UPMC Health Plan
07.2018 - 08.2019
Coordination of Benefits Specialist
UPMC Health Plan
10.2016 - 07.2018
Kitchen Manager
Chipotle
05.2015 - 10.2016
MBA - Business Administration And Management
Youngstown State University
Bachelor of Science - Agricultural Science
Pennsylvania State University