John Galardi

Work History

Aetna

Review various forms of documentation during the course of investigations - including letters, claims, enrollment documents and audio recordings
Generated reports related to grievance volume, outcomes and category
Recognize trends and investigate them to identify deeper causes and implications
Document all findings to a centralized cloud-based database for utilization across the team

UPMC Health Plan

Generate reports using SQL – Claims Adjustment and Quality Audit
Analyze findings and explain results to non-technical audience - including Third Party Administration leadership (TPA) and TPA clients
Ensure reconciliation of claim adjustment projects
Create and maintain team SharePoint site with policies and procedures, as well as edit updates contributed by other users
Identify areas of concern that may compromise client satisfaction and propose solutions based on findings, expertise and research
Serve on TPA leadership team – requiring thorough knowledge of client performance expectations, department goals and objective

UPMC Health Plan

Collection of information for Late Enrollment Penalty Appeals for submission to MAXIMUS Federal Services
Facilitated second-level review hearings and internal appeals
Reported complaint and grievance data to regulatory bodies and internal departments
Interpreted medical information, recognized trends and identified opportunities for improvement within the Health Plan
Utilized proprietary cloud-based Customer Relations Management database system for processing and maintaining member information and communication, as well as corporate messaging and follow-up

UPMC Health Plan

Increased efficiency and team productivity by promoting operational best practices.
Designated Trainer Express Scripts Pharmacy System for the Medicaid/CHIP team
Department leader in member satisfaction
Assisted UPMC members with various health insurance products, including Medicaid, Medicare and Special Needs Plan (SNP), and Children’s Health Insurance Plans (CHIP)
Verified and advised members of eligibility, plan design, claims, and pharmacy benefits

Marine Corps

Led security team during overseas operations in Afghanistan, providing security and support for supply convoys in the Helmand Province
Served as Corporal of the Guard, managed security for Command Offices at the Marine Logistics Group compound
Awarded Afghanistan Campaign Medal, NATO ISAF Medal, Meritorious Mast and Combat Action Ribbon
Honorary Discharge

Self Employed

Maintained operational facilities attractive to potential tenants by organizing regular maintenance, major repairs, and capital improvement projects.
Maximized rental income while minimizing expenses through effective planning and control.
Monitored timely receipt and reconciliation of rent collections in accordance with landlord and resident statutes.