Josue Nieves
Vernon,CT
Summary
Well-qualified Entrepreneur with proven success in improving operations and solving problems. Highly proficient in building lasting relationships with key decision makers, customers and team members to further company goals. Ready to leverage training and experience to take on new professional challenges.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Real Estate Sales Associate
Eagle Eye Realty
02.2019 - Current
- Multi-million dollar producing listing agent with a focus on Residential and Commercial properties throughout the entire state of Connecticut.
- Liaised between buyers and sellers during the home buying/selling process to facilitate appropriate loans, inspections, and credit reports.
- Generated leads for sales and rental properties through four hours of daily cold calling, interviews, marketing and referrals.
- Managed contracts, negotiations, and all aspects of sales to finalize purchases and exceed customer expectations.
Provider Engagement Administrator II
Centene Corporation/HealthCare Support
01.2024 - 04.2024
- Act as a liaison between Tier II providers (large PCP groups) and WellCare Health Plan.
- Review Provider performance goals with providers and manage Network performance for assigned territory through a consultative/account management approach.
- Drive provider performance improvement in the following areas: Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization.
- Facilitate provider trainings, orientations, educate providers regarding tools utilization, policies and procedures, and performance improvement within the network.
- Investigate, resolve, communicate, and assist with claim issues/resolution and changes.
- Present detailed HBR analysis and create reports for Joint Operating Committee meetings (JOC) and assist with special projects as assigned.
Senior Business Analyst
United Healthcare
12.2018 - 09.2019
- Conducted and managed requirements gathering sessions with internal/external clients used to configure a claims processing system.
- Analyzed root cause issues, problem solved and implemented business intelligence solutions to increase operational efficiency.
- Supported the configurations team throughout the entire implementation process with reporting, analysis, project management and business presentations to increase production and quality.
- Developed complex dashboard and reporting tools to track business performance metrics.
- Resolved complex business problems (technical, product, service, process, operations and organizational) and developed innovative solutions.
- Collaborated with stakeholders to identify business needs ,data sources, assess risks and effectively deliver solutions.
- Managed team performance by implementing measurable metrics to track delivery of supporting requirement artifacts and results.
Senior National Quality Manager
United Healthcare
12.2017 - 12.2018
- Determined quality department standards, practices, and procedures by managing the quality and production of all off-shore vendors located in India Ireland and Atlanta which exceeded 1,000 contract loaders.
- Worked effectively in a fast-paced environment by facilitating training, mastermind calls involving leadership, clients and stakeholders to achieve tight deadlines and exceed aggressive quality results across the organization.
- Established and tracked quality department goals and objectives by creating business rules/processes, error remediation plans and suggested improvements to daily functionality in order to increase productivity across multiple platforms.
- Tracked and reported quality performance issues and resolutions via Project Management to internal and external stakeholders.
Senior Provider Data Analyst - Audit
United Healthcare
08.2015 - 12.2017
- Audited Commercial, Medicare and Medicaid contracts loaded across several platforms.
- Identified, analyzed and interpreted trends or patterns in complex data sets and effectively communicated back to Management.
- Participated in requirements meetings to understand business needs.
Provider Installation Specialist
United Healthcare
09.2012 - 08.2015
- Responsible for the installation, administration and database loading of assigned provided contracts for Military and Veteran families (TRICARE)
- Used pertinent data and facts to identify and solve a range of problems within an area of expertise.
- Tracked and reported discrepancies, trends and issues impacting several platforms across the organization.
Business Analyst/Underwriting Assistant
Equity Staffing/United Healthcare
08.2011 - 12.2011
- Supported the Underwriting team by managing the workflow coordination in the Specialty Benefits Department.
- Data Management: Assigned cases to underwriters, RFP data and ran queries/manual rates.
- Created quality/production and financial reports and collaborated with Underwriters to improve processing.
Education
No Degree - Accounting, Business Management
Capital Community College
Real Estate Sales
Greater Hartford Association of Realtors
High School Diploma -
Hartford Public High School
06.2001
Skills
- Business Analysis
- Customer Service
- Project Management
- Business Consultant
- Data Analysis
- Quality Assurance
- Customer Needs Assessment
- Contract Negotiation
- Business Process Improvement
- Requirements Gathering
- Underwriting
- Internal Auditing
Affiliations
National Association of Realtors
Certification
- Licensed Real Estate Sales Associate - 2019 - Current
Languages
Spanish
Native or Bilingual
Timeline
Provider Engagement Administrator II
Centene Corporation/HealthCare Support
01.2024 - 04.2024
Real Estate Sales Associate
Eagle Eye Realty
02.2019 - Current
Senior Business Analyst
United Healthcare
12.2018 - 09.2019
Senior National Quality Manager
United Healthcare
12.2017 - 12.2018
Senior Provider Data Analyst - Audit
United Healthcare
08.2015 - 12.2017
Provider Installation Specialist
United Healthcare
09.2012 - 08.2015
Business Analyst/Underwriting Assistant
Equity Staffing/United Healthcare
08.2011 - 12.2011
No Degree - Accounting, Business Management
Capital Community College
Real Estate Sales
Greater Hartford Association of Realtors
High School Diploma -
Hartford Public High School
- Licensed Real Estate Sales Associate - 2019 - Current
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