JAIME CARTER-UPTON
Davenport,Ia.
Summary
Knowledgeable and dedicated customer service professional with extensive experience in healthcare industry. Solid team player with outgoing, positive demeanor and proven skills in establishing rapport with clients. Motivated to maintain customer satisfaction and contribute to company success. Specialize in quality, speed and process optimization. Articulate, energetic and results-oriented with exemplary passion for developing relationships, cultivating partnerships and growing businesses.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Recovery/ReSols Anlyst
UHC Benefit Ops - Provider
, IA TELECOMMUTER
05/21/23 - Current
- Investigated, recovered, and resolved various types of claims for health plans, commercial customers, and government entities
- Contacted members, providers, and insurance companies via phone calls or email to ensure accurate coordination of benefits
- Conducted investigations and pursued recoveries and payables on subrogation claims, efficiently managing file processes.
- Streamlined claim processing through effective process recovery methods
- Consistently followed all state and federal compliance policies, reimbursement policies, and contract compliance
Service Account Manager Associate
Optum
Davenport, IA
04.2017 - 05.2023
- Successfully maintained client relationships and ensured efficient claims service delivery, contributing to enhanced client retention and membership growth.
- Provide one - on - one and large group client claims process training in person, via Teams, or conference call
- Provided subject matter expertise in C&S and conducted training for new hires
- Pioneered support for all UHC C&S plans on the CSP platform with a focus on providing exceptional expertise and customer service to members, customers, and providers.
- Serve as liaison to complex customer base to manage first level response and resolution of escalated issues with internal customers
- Identify and resolve operational problems using defined processes, expertise and judgment
- Investigate claim and/or customer service issues as identified and communicate resolution to customers
- Assisted colleagues in identifying areas for improvement and offered constructive feedback
- Act as Ambassador for the company while solving complex health care inquires and as a customer advocate to resolve escalated and complex issues.
- Maintained positive customer relations by addressing problems head-on and implementing successful corrective actions.
- Utilized a range of tools like Facets CSP and CMC to optimize work processes. Experience with COSMOS system integration that includes ISET ICUE applications as well as NICE for enhanced performance. Proficient in utilizing Pulse WebCSA along with ECHO Doc360 to streamline operations.
Tier 1 Provider Resolution Specialist
United Health Care
Moline, IL
07.2014 - 04.2017
- Provided excellent customer service by leveraging in-depth understanding of products and services, resulting in welcoming and positive interactions with customers.
- Managed high-volume call flow with a focus on addressing customer needs and concerns effectively.
- Providing excellent customer service while consistently meeting productivity, schedule adherence, and quality standards
- Sustained strong work ethic, resulting in continuous productivity
- Gained extensive experience using telephone and computer to perform various job duties in an office setting environment for a duration of over one year
- Applies basic knowledge of theories, practices and procedures in a function or skill
- Applied existing procedures and facts to successfully solve routine problems or conduct routine analyses
- Oversaw the administrative procedures for member intake and managed the flow of information during admission and discharge
- Collaborated with healthcare organizations, clinics, and facilities to effectively handle service requests from members and providers.
- Enhanced efficiency by reviewing and ensuring compliance with adverse determination, approval notification, and processing notification requirements
- Supported clinical staff by organizing documents and triaging cases for clinical coverage review.
Salon Director
Sun Tan City
Davenport , IA
10.2013 - 03.2014
- As Salon Director, I was responsible for maintaining working relationship with with all employees and area businesses, handling certain administrative tasks, obtaining and managing resources for Salon operations and activities, and providing leadership and direction on Salon activities
- Established and maintained two-way communication with forward deployed units to ensure timely and accurate information and to resolve issues
- Maintained communication with Salon supplying information as available to command chain at host unit
- Served as official information source for families
- That included conducting information briefings, preparing postings for management meetings, and reviewing management information
- Also ensured marketing information and management information bulletins were published on regular basis
- Maintained regular connection with families and management
- Helped Coordinate with management meetings in conjunction with District leaders, district, and community resources to support consumers.
Education
Associates Degree - Applied Science-Human Service
Kaplan University
03.2010
Skills
- Account services
- Excellent customer service
- Account acquisition and retention
- Monitoring accounts
- Community and State specialist
- Issue Identification
- Documentation And Reporting
- Workflow Analysis
- Regulatory Compliance
- System Analysis
- Root Cause Analysis
- Evidence-Based Decision Making
Affiliations
- President VFW Auxillary 2153
Certification
- CPR and AED certified
References
References available upon request.
Timeline
Service Account Manager Associate
Optum
04.2017 - 05.2023
Tier 1 Provider Resolution Specialist
United Health Care
07.2014 - 04.2017
Salon Director
Sun Tan City
10.2013 - 03.2014
Recovery/ReSols Anlyst
UHC Benefit Ops - Provider
05/21/23 - Current
Associates Degree - Applied Science-Human Service
Kaplan University