Jaime Schweers
West Seneca,NY
Summary
A highly motivated and experienced Health Insurance Specialist with and in-depth knowledge of the insurance industry. Possessing excellent customer service,communication and problem-solving skills, as well as the ability to work collaboratively and independently.
Overview
10
10
years of professional experience
Work History
Network Manager, Specialty Network Services | Optum Behavioral Health
UnitedHealth Group
Tonawanda, USA
05.2023 - 10.2024
- Responsible for day-to-day provider interaction for Commercial/Medicaid outpatient ABA therapy providers in New York, Rhode Island, and Vermont
- Conduct provider outreach for outpatient behavioral health provider/agency/group network expansion
- Manage provider expectations regarding timelines for contracting, credentialing, reimbursement levels and site audits
- Review, issue, collect and submit provider applications, agreements and required state law credentialing documents
- Coordinate and follow-up with Optum provider relations advocates to ensure timeliness of submission of applications and related documents
- Actively participate in outpatient behavioral health meetings
- Understand health plan provider contracts and draft counter language
- Develop, update and maintain numerous fee schedules
Service Account Manager
UnitedHealth Group
Tonawanda, USA
06.2017 - 05.2023
- Responsible for day-to-day client interaction on escalated issues for 8 clients
- Liaison between United Healthcare National Advocacy and clients to research and resolve employer escalated member call and claim issues that were not resolved through traditional channels regarding pharmacy, behavioral health medical claims
- Works with account management team to maintain business
- Manages reporting of High Dollar claims, appeals, business goals, service level guarantees and member surveys
- Responsible for training of advocates on client plans/changes to insure a successful open enrollment
- Works closely with the Account Management Team to maintain business
- Responsible for building/maintaining relationships with various internal departments including implementation, Optum Clinical, United Behavioral Health, and Optum RX
- Provides education to members/clients on types of plan offerings
- Educate through proactive, meaningful conversations about managing health and wellbeing, maximizing the value of their health plan benefits, and choosing a quality care provider
Equity Health Super-Agent / Concierge Specialist
UnitedHealth Group
Tonawanda, USA
01.2017 - 06.2017
- Working closely with agents/supervisor and clinical team to resolve urgent/complex issues
- Research issues to determine route cause with resolution
- Own problems through resolution in real time or through commitments
- Provide coaching to agents to further success
- Call listening to ensure process/model is being followed
- Correspondence to team on changes/updates with Equity clients
- Assist team with highly escalated calls
- Team lead assisting in all manager/Equity duties upon absences/PTO
Benefit Advocate
UnitedHealth Group
Tonawanda, USA
03.2015 - 01.2017
- Provide knowledge and customer service support to our members and providers both internally and externally
- Answer 40-60 incoming calls per day from members on health plan
- Research complex issues and provide education on benefits
- Own problems through resolution on behalf of member, in real time or through commitments
- Assigned team referral champ
- Responsible for building team morale, tracking team progress, providing additional scripting and tips to ensure team success
- Working closely with supervisor to lead team contests and set milestones for maximum progress
- Leading team over 2 month span from 7% team overall standing to current rate of 13%
- Research highly escalated issues to ensure timely resolution
- Assist supervisor team with highly escalated calls
- Resource for team assisting in coaching and point of contact for questions/issues in supervisors absence
- Interim OJT Coach
- Provider support to new hires during the training process through one on one and group coaching
- Call listening/y-cording to insure process is being followed
- Feedback provided through weekly emails to trainees including stats with strengths and opportunities
- Provided coaching on UES and quality errors
- Worked closely with trainer to facility learning activities
Education
Some College (No Degree) - Business Administration
Niagara County Community College
Sanborn, NYSkills
- Microsoft Office
- Customer Skills
- De-escalation Skills
- Leadership Qualities
- Critical Thinking
- Problem-Solving Skills
- Written Communication
- Verbal Communication
- Customer Support
- Problem Resolution
Timeline
Network Manager, Specialty Network Services | Optum Behavioral Health
UnitedHealth Group
05.2023 - 10.2024
Service Account Manager
UnitedHealth Group
06.2017 - 05.2023
Equity Health Super-Agent / Concierge Specialist
UnitedHealth Group
01.2017 - 06.2017
Benefit Advocate
UnitedHealth Group
03.2015 - 01.2017
Some College (No Degree) - Business Administration
Niagara County Community College
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