Juliet Rich-Hopkins
Summary
Talented Team Leader experienced and dedicated to enhancing employee satisfaction and business success. Diplomatic and friendly with proven commitment to employee training. Hardworking team player bringing necessary experience and knowledge to tackle any operational demand.
Overview
11
11
years of professional experience
Work History
Managing Team Leader
Healthfirst
06.2019 - Current
- Monitored team performance and provided constructive feedback to increase productivity and maintain quality standards.
- Supervise 14 team members to confirm compliance with set procedures, quality and review rate requirements.
- Worked with team to identify areas of improvement and devised solutions based on findings.
- Built strong relationships with customers through positive attitude and attentive response.
- Stay abreast of best practices both internally and externally and provide a conduit for introducing those practices to the team.
- Support strategic business initiatives to continuously improve internal processes that optimize internal controls and reduce cost and risk to company.
- Responsible for proving monthly statistical reports to senior leaders regarding quality and performance measurements.
Medical Underwriter
UnitedHealthcare
08.2018 - 01.2019
- Determined eligibility for a specific Medicare product or plan by reviewing the applicant's medical history via the medical application, direct interview with client, claims utilization, and pharmacy profile to identify medical risk represented in terms of high utilization of services.
- Studied insurance industry changes, remaining up-to-date with latest trends, protocols and compliance requirements.
- Evaluated applications to determine insurance coverage and appropriate risk classifications.
- Collaborated with senior underwriters to help develop innovative underwriting solutions to assist junior underwriters in the accurate processing of applications.
Senior Appeals Administrator
Kaiser Foundation Health Plan Of The Northwest
12.2012 - 01.2018
- Effectively managed and resolved a high volume of complex, highly regulated complaints, grievances, and appeals in compliance with state and federal regulations and internal policies, verbally or in writing within designated regulatory time frames. d
- Developed training materials for new staff and supported departments director in day-to-day operations as part of a mentorship opportunity.
- Drove operations success by actively analyzing and reporting contractual or administrative deficiencies and trends.
- Prepared case summaries in response to formal inquiries from CMS, Office of Personal Management for federal products, Oregon and Washington Insurance Divisions, attorneys, governmental officials, brokers, and network providers.
- Attended legal hearings to provide testimony and for depositions, represented department during legal proceedings for high dollar/profile grievances and appeal determinations.
- Assisted and provided support to physicians and clinical staff in the management of patients with behavioral issues or noncompliance to help mitigate allegations of abuse or substandard care to ensure optimal outcomes.
Education
MBA - Health Management And Clinical Assistance
Marylhurst University
Marylhurst, OR06.2016
BBA - Business Administration And Management
American InterContinental University
Schaumburg, IL05.2011
Skills
Word, Excel, PowerPoint, SharePoint, OneNote, Outlook; EMR Systems, MBI, Sharepoint; Excellent Customer Service Skills; Training and Supervision; Health and Life Underwriting; New Product Management and Contract Interpretation; ICD 10 and HCPCS coding, Advanced Level Written and Verbal Communication skills
Timeline
Managing Team Leader
Healthfirst
06.2019 - Current
Medical Underwriter
UnitedHealthcare
08.2018 - 01.2019
Senior Appeals Administrator
Kaiser Foundation Health Plan Of The Northwest
12.2012 - 01.2018
MBA - Health Management And Clinical Assistance
Marylhurst University
BBA - Business Administration And Management
American InterContinental University
Similar Profiles
Sophie XiongSophie Xiong
Care Coordinator at HealthfirstCare Coordinator at Healthfirst
Mauricio NavarroMauricio Navarro
Manager at HealthFirstManager at HealthFirst
Kyle CurtinKyle Curtin
Learning Delivery Specialist at HealthfirstLearning Delivery Specialist at Healthfirst
Fiza ImamFiza Imam
Integrated Products Project Liaison at HealthfirstIntegrated Products Project Liaison at Healthfirst
Christina PaulChristina Paul
Managing Broker and Team Leader at Partners Home Group LLCManaging Broker and Team Leader at Partners Home Group LLC