Maria Gilard
St. Peters,MO
Summary
Dynamic Client Services and Healthcare Professional with expertise in case management, fraud investigation, and client retention. Managed teams, increasing productivity by over 80%, and resolved 95% of cases. Skilled in prior authorizations, compliance, and client management, ensuring high satisfaction and 98% retention rates.
Overview
11
11
years of professional experience
Work History
Client Services Account Manager
City of St. Louis, MO
St. Louis, MO
08.2021 - Current
- Manage and mentor a team of 5+ client service representatives, driving a 20% increase in team productivity and enhancing client satisfaction by 15%.
Orchestrate and maintain client relationships across multiple communication channels, ensuring a 95% client retention rate over two years.
Deliver comprehensive case management services for over 200 clients, focusing on retaining home health workers, which has resulted in a 98% retention rate of home health aides.
Develop and implement individualized care plans, coordinating with healthcare providers to improve client health outcomes by 15%.
Provide timely and personalized support to a portfolio of 50+ clients, achieving a 98% on-time delivery rate for client requests and projects.
Fraud Investigator Specialist
United Healthcare Group
Maryland Heights, MO
09.2018 - 05.2020
- Conducted fraud investigations on over 100 cases, ensuring that companies did not charge insurance providers for DME (Durable Medical Equipment) products that clients never received.
Made an average of 200 calls daily to verify claims, communicate with clients, and gather necessary information, maintaining a high level of accuracy and efficiency.
Ensured strict compliance with company policies and industry regulations, reducing the risk of fraudulent activities and saving the company significant costs.
Reviewed Medicaid and Medicare reports to identify discrepancies and potential fraud, contributing to a 20% reduction in erroneous claims.
Led weekly team meetings to discuss case progress, share insights, and strategize on improving investigation processes, resulting in a 15% increase in team productivity.
Customer Retention Specialist
United Healthcare Group
Saint Peters, MO
09.2014 - 09.2018
- Achieved a 90% customer satisfaction rate by providing exceptional service and resolving client concerns effectively.
- Resolved issues for over 150 clients, resulting in increased client satisfaction and a notable decrease in customer complaints by 25%.
- Assisted with implementing policy changes, contributing to a smoother client experience and ensuring alignment with company standards.
- Collaborated with various departments to address client needs, ensuring that all inquiries and issues were handled promptly and efficiently.
- Identified opportunities for process improvements, which led to a reduction in client escalations and improved retention rates.
Prior Authorization Specialist
United Healthcare Group
Saint Peters, MO
10.2013 - 09.2014
- Assisted over 300 clients in obtaining prescription authorizations, ensuring timely access to necessary medications.
- Utilized Stars software and expertise in ICD-9 codes to accurately process and track prior authorization requests, maintaining a resolution rate of over 95%.
- Conducted thorough reviews and revisions of authorization requests, leading to a personal productivity increase of over 80%.
- Proactively reached out to healthcare providers to secure necessary authorizations, resulting in a significant reduction in processing times and improved client satisfaction.
- Managed the full cycle of prior authorization processes, from initial request to final approval, ensuring compliance with all relevant regulations and policies.
Education
Bachelor of Science - Criminal Justice
Southeast Missouri State University
07.2015
Skills
- Case Management & Client Advocacy
- Fraud Investigation & Compliance
- Client Relationship Management
- Prior Authorization & Healthcare Processes
- Team Leadership & Collaboration
- Process Improvement & Productivity Enhancement
Accomplishments
Completed Bank of America Institute at Cornell University's certificate program in Women's Entrepreneurship, underscoring a commitment to continuous personal and professional growth.
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Work Preference
Work Type
Full TimeWork Location
RemoteHybridImportant To Me
Career advancementWork-life balanceCompany CultureFlexible work hoursHealthcare benefitsWork from home optionPaid time off401k matchPaid sick leave4-day work weekQuote
"Driven by results and guided by empathy, I believe in the power of efficient processes and strong client relationships to create lasting positive outcomes in every role I undertake."
Personal Quote
Languages
English
Native language
Interests
Client Advocacy
Healthcare Compliance
Art
Timeline
Client Services Account Manager
City of St. Louis, MO
08.2021 - Current
Fraud Investigator Specialist
United Healthcare Group
09.2018 - 05.2020
Customer Retention Specialist
United Healthcare Group
09.2014 - 09.2018
Prior Authorization Specialist
United Healthcare Group
10.2013 - 09.2014
Bachelor of Science - Criminal Justice
Southeast Missouri State University
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