Kevin Ulino

• Oversaw daily claims processing operations to ensure compliance with regulations.
• Managed Third-Party Liability and Subrogation issues, safeguarding company interests.
• Resolved Medicare coordination of benefits issues to ensure accurate claims processing.
• Investigated claims issues to identify correct primary payer, ensuring accurate resolution.
• Coordinated benefits for Workers' Compensation cases, enhancing claims processing efficiency.

Internal Contracting/Single Patient Agreements.

· Negotiates rates with non-par physicians and facilities to obtain a mutually agreeable rate for payment within the plan’s allowable claim limits.

· Puts Single Patient Agreements and/or Direct Contracts into place to avoid back- end balance bills and appeals settlements.

· Receives and logs all fully executed agreements, ensures they are attached to members’ files and forward to the appropriate TPA.Collaborated with IT teams to enhance claims processing systems and tools.

• Analyzed workflow processes to identify areas for operational improvements.
• Managed vendor relationships to streamline external claims handling services.
• Implemented quality assurance measures to maintain high standards in claims review.
• Collaborated with other departments within the organization to develop strategies for improving overall operational effectiveness.

• Led claims processing operations to ensure timely and accurate claim resolutions.
• Implemented process improvements to enhance efficiency in claims handling workflows.
• Established quality assurance protocols, ensuring high standards in claims processing and enhancing overall service quality.
• Oversaw team performance metrics to identify areas for operational enhancement.
• Reviewed customer service production and quality data to identify trends and areas for improvement
• Identified and investigated COB issues
• Processed third-party Medicare Supplemental and dental claims
• Managed extensive phone and email communications with stakeholders.
• Collaborated with IT to optimize claims management systems and tools integration.
• Performed root cause analysis on recurring issues within the department in order to identify potential solutions or corrective actions needed.

Internal Contracting/Single Patient Agreements.

· Negotiates rates with non-par physicians and facilities to obtain a mutually agreeable rate for payment within the plan’s allowable claim limits.

· Puts Single Patient Agreements and/or Direct Contracts into place to avoid back- end balance bills and appeals settlements.

· Receives and logs all fully executed agreements, ensures they are attached to members’ files and forward to the appropriate TPA.

• Handle escalated issues and supervise customer service staff in absence of supervisor
• Managed phone and written communication with clients to resolve inquiries and provide effective support.
• Process Medicare Supplemental claims
• Identify and investigate COB issues
• Collaborated with diverse coworkers to achieve goals and resolve product and service-related issues.
• Collaborated closely with team members to achieve project objectives and meet deadlines.

Internal Contracting/Single Patient Agreements (HI Card)

· Negotiates rates with non-par physicians and facilities to obtain a mutually agreeable rate for payment within the plan’s allowable claim limits.

· Puts Single Patient Agreements and/or Direct Contracts into place to avoid back- end balance bills and appeals settlements.

· Receives and logs all fully executed agreements, ensures they are attached to members’ files and forward to the appropriate TPA.

• Worked effectively in team environments to make the workplace more productive.

• Managed high volume of phone and written communications with clients, ensuring timely issue resolution and enhanced client satisfaction.
• Reviewed customer service production and quality data to identify trends and improve service delivery.
• Oversaw team operations during supervisor's absence to maintain workflow and productivity.
• Processed third-party Medicare Supplemental and dental claims, contributing to accurate claims management and timely reimbursements.
• Identified and investigated COB issues
• Updated and maintained provider files as necessary

• Provided excellent customer service when interacting with clients.
• Managed special projects while resolving complex problem accounts to enhance customer satisfaction.
• Crafted customer service strategies that aimed to drive increased sales revenue.
• Provided constructive feedback to customer service management.
• Heavy phone and written communication with other insurance companies, attorneys, provider billing departments, group benefit administrators, and members.
• Maintained department records by tracking recovered funds from improperly paid claims and monitoring expected savings from avoidance issues.

• Resolved Medicare coordination of benefits issues
• Identified and investigated claims issues to determine correct primary payer, ensuring timely resolution.
• Managed coordination issues effectively in conjunction with Workers' Compensation cases
• Handled Third-Party Liability and Subrogation issues, coordinating with relevant parties to facilitate claim processing.
• Conducted research on unpaid claims involving complex coordination of benefits and Medicare Secondary Payer rules, contributing to resolution efforts.
• Collaborated with other departments within the organization on projects involving coordination of written communications.
• Demonstrated expertise of products by providing detailed information on product features and benefits.
• Educated customers on effects, medical benefits and overall experience of using cannabis products.
• Negotiated terms and conditions of contracts with vendors to maximize benefits for the organization.