James M. Wuest
Mount Washington,KY
Summary
Healthcare operations and provider relations leader with 25+ years of experience driving customer success, healthcare technology adoption, operational improvements, and cross-functional collaboration. Proven record of building trusted provider partnerships, leading implementations, educating stakeholders, improving workflows, and exceeding performance goals.
Overview
33
33
years of professional experience
Work History
Customer Success Liaison
Nsight Health
Louisville, Kentucky
11.2024 - 08.2026
- Strengthened provider partnerships, onboarded patients, educated clinics on RPM, resolved issues proactively, met enrollment goals, and improved retention.
- Coordinated communication between Nsight Health patients and care teams.
- Managed referral requests with providers and specialty offices.
- Scheduled appointments across clinic calendars and service lines.
- Resolved patient concerns through clear, professional follow-up.
- Verified insurance details for service coordination and access.
- Documented case updates in healthcare records and tracking systems.
- Guided patients through Nsight Health intake and care steps.
- Collaborated with staff to support smooth clinic operations.
- Coordinated communications between teams to ensure accurate information was shared in a timely manner.
- Displayed strong telephone etiquette, effectively handling difficult calls.
- Ensured compliance with relevant legislation when carrying out liaison activities.
- Maintained up-to-date records of all interactions with customers or clients.
- Developed and maintained effective relationships with internal and external stakeholders.
- Acted as a point of contact for customers, suppliers, partners and other third parties to support the delivery of services.
- Oversaw quality control to identify inconsistencies and malfunctions.
- Utilized EHR systems to verify and qualify patients based on ICD10 codes and insurance plan coverage
eBusiness Consultant
Humana
Louisville, KY
01.2007 - 05.2024
- Managed provider relationships, expanded electronic adoption, delivered national webinars, served as SME for Availity/HIPAA X12, and improved provider experience.
- Advised Humana business teams on process improvements and operational planning
- Prepared Humana reports, summaries, and presentations for leadership review
- Guided project coordination across Humana departments and external partners
- Facilitated Humana meetings to align goals, tasks, and follow-up actions
- Identified opportunities for business growth through new products or services.
- Assisted with creating marketing campaigns to increase sales and brand awareness.
- Recommended cost-cutting measures without sacrificing quality or service levels.
- Coordinated with internal teams and external stakeholders to support business growth through development of new features.
- Coached employees on best practices in order to improve their job performance.
Grievance & Appeals Specialist
Humana
Louisville, KY
01.2003 - 01.2007
- Resolved Medicare/Medicaid appeals while ensuring regulatory compliance and identifying process improvements.
- Reviewed Humana member grievance and appeals files for policy compliance
- Documented appeal decisions in Humana case management systems
- Coordinated with clinical teams on Medicare and Medicaid appeal reviews
- Communicated denial and approval notices to members and providers
- Escalated complex grievances to appropriate Humana review channels
- Maintained accurate records for appeal timelines and correspondence
- Resolved member concerns with clear, empathetic service support
Assistant Manager
YUM! Brands
Louisville, KY
01.2001 - 05.2002
- Led staffing, hiring, scheduling, inventory, and daily operations.
- Supervised restaurant operations at YUM! Brands locations under brand standards.
- Scheduled crew shifts and coordinated daily coverage for smooth service.
- Trained team members on food safety, guest service, and cash handling.
- Monitored inventory levels and ordered supplies for restaurant readiness.
- Resolved customer concerns and supported positive guest experiences.
- Enforced health, safety, and sanitation compliance across store operations.
- Coached crew performance and reinforced YUM! Brands operating procedures.
- Supervised daily operations including scheduling shifts, assigning duties.
- Maintained up-to-date knowledge of company products and services.
- Monitored employee attendance records, timekeeping, and payroll information.
- Ensured compliance with safety regulations and company policies.
- Provided guidance and support to junior staff members on daily tasks, projects, and objectives.
- Resolved conflicts between team members in an effective manner.
- Organized training sessions for new hires to familiarize them with the workplace environment.
- Selected as part of the initial management team supporting Yum! Brands’ early co-branding strategy, participating in the launch of the company’s first co-branded corporate-owned locations in Louisville.
- Completed cross-brand management training for Taco Bell and Long John Silver’s and applied that training to support the integration of multiple restaurant concepts within KFC locations.
- Contributed to the successful implementation of a new operating model during the early stages of Yum! Brands’ co-branding initiative, helping establish processes and management practices for future expansion.
Project Manager
Henderson, A Bracknell Company
Louisville, KY
08.1999 - 01.2001
- Directed nationwide telecom projects, supervised teams, managed budgets and timelines.
- Led project delivery for Henderson, A Bracknell Company, across client and site teams.
- Managed stakeholder communications with clients, contractors, and internal Henderson teams.
- Monitored budgets, costs, and contract changes throughout project lifecycles.
- Directed risk reviews, issue logs, and action tracking for active projects.
- Prepared reports, status updates, and meeting notes for leadership and clients.
- Supervised project resources, vendors, and cross-functional workstreams.
- Reviewed delivery standards, specifications, and compliance requirements across Henderson projects.
- Managed multiple projects with competing deadlines simultaneously.
- Developed and maintained project plans, timelines, and budgets.
- Built and established strong partnerships with teams, vendors and contractors.
- Led meetings with internal team members, consultants and contractors.
- Provided guidance to team members regarding tasks assigned to them.
Insurance Agent
Kentucky Farm Bureau
Louisville, KY
05.1996 - 01.1999
- Built and managed a $1M book of business through consultative sales and service.
- Advised Kentucky Farm Bureau clients on auto, home, and life coverage options.
- Prepared insurance quotes and policy applications using agency systems.
- Reviewed coverage needs and recommended updates for changing client situations.
- Processed policy changes, renewals, and billing questions with accuracy.
- Explained deductibles, limits, and exclusions in clear client language.
- Coordinated with underwriting and claims teams on policy service requests.
- Maintained client records and account notes in company CRM systems.
- Built referral relationships through community outreach and customer follow-up.
- Educated customers on the importance of maintaining adequate insurance coverage.
- Prepared documents such as applications, endorsements, renewals, cancellations, or other forms required by law or company procedures.
- Responded to customer inquiries and problems to promote great service.
- Provided customers with information regarding plan features, pricing, and availability.
- Maintained accurate records of all insurance transactions using computer software systems.
- Developed relationships with new clients through cold calling and referrals from existing customers.
- Assessed customer risk levels and recommended appropriate coverage options.
- Conducted telephone appointments with prospective clients to build rapport and sell insurance services.
- Conducted meetings or phone calls with potential clients to present insurance policies and answer questions.
- Explained complex technical terms related to insurance plans in simple language for easy understanding.
- Engaged customers and provided high level of service by carefully explaining details about documents.
- Participated in continuing education courses to stay current on industry trends and changes in regulations.
- Developed and implemented comprehensive insurance plans for clients according to their individual needs.
Assistant Manager
Brown-Noltemeyer Company
Louisville, Kentucky
01.1994 - 01.1996
- Supported management of apartment communities, leasing operations, and administration.
- Coordinated tenant requests, work orders, and follow-up with property management office teams.
- Reviewed lease documents, renewal files, and compliance records for property management operations.
- Resolved resident concerns and enforced community policies with clear, professional communication.
- Monitored building conditions and directed repairs for safe, orderly property environments.
- Trained onsite staff on procedures, customer service, and daily property workflows.
- Prepared monthly financial statements detailing income from rentals and expenses incurred by the property management office.
- Reviewed applications from prospective tenants and conducted background checks before approving them for tenancy.
- Responded promptly to emergency calls from tenants concerning problems such as water leaks or power outages.
- Ensured that tenant files contained accurate information on leases and rental agreements.
- Monitored tenants' complaints and ensured that they were addressed in a timely manner.
Education
B.A. - Political Science
University of Louisville
Insurance Certification — Commonwealth Schools of Insurance -
Skills
- Microsoft Office Suite
- WebEx
- TEAMS
- Slack
- Bomgar
- Availity
- EDI
- HIPAA X12
- Humana Provider Systems
- Mainframe Systems
- Windows
- EHR documentation
- Insurance verification
- Referral coordination
- ICD-10 coding
- National training (webinar and onsite)
- HIPAA compliance
- Clear communication
Accomplishments
- Supported healthcare providers nationwide in adopting electronic solutions that improved efficiency and reduced administrative costs.
- Built strong physician and clinic relationships that increased Remote Patient Monitoring enrollment and patient engagement.
- Planned and delivered national provider education webinars and remote training.
- Led multi-state technical projects while supervising cross-functional teams and managing budgets and schedules.
- Managed a $1M insurance book of business through consultative relationship management.
Raw Text Notes
Year-only dates were converted to MM/DD/YY using 01/01/YY for start and 12/31/YY for end., Only the top location line was provided; street/zip were not present in the resume.
Core Expertise
- Provider Relations
- Customer Success
- Healthcare Operations
- Project Management
- RPM
- Medicare & Medicaid
- Process Improvement
- Team Leadership
- HIPAA
- EDI
- Training
- Stakeholder Engagement
Timeline
Customer Success Liaison
Nsight Health
11.2024 - 08.2026
eBusiness Consultant
Humana
01.2007 - 05.2024
Grievance & Appeals Specialist
Humana
01.2003 - 01.2007
Assistant Manager
YUM! Brands
01.2001 - 05.2002
Project Manager
Henderson, A Bracknell Company
08.1999 - 01.2001
Insurance Agent
Kentucky Farm Bureau
05.1996 - 01.1999
Assistant Manager
Brown-Noltemeyer Company
01.1994 - 01.1996
B.A. - Political Science
University of Louisville