Mark Escalera
Oroville,USA
Summary
Seeking a long-term position where my extensive experience in Account Management, Operations, Claims Research, and Relationship Building can contribute to achieving and surpassing company goals.
Overview
38
38
years of professional experience
Work History
Network Program Consultant
West Region Network Analytics Team
05.2025 - Current
- Analyzed reports from the HSD system to identify variances between Medicare provider requirements and contracted providers within the network.
- Utilized internal tools to verify provider directory accuracy, ensuring erroneously removed providers were reinstated to active status.
- Conducted research on prospective and market providers to address network gaps and maintain regulatory compliance.
- Collaborated with stakeholders to support network adequacy and ensure alignment with Medicare standards and CMS Guidelines
Hospital and Facility Advocate
Provider Group Advocate
01.2024 - 04.2025
- Maintained and grew relationships with provider groups and hospitals in Southern California.
- Resolved provider group issues in real-time and managed complex projects.
- Acted as the point of contact for internal partners regarding verification and project management.
- Educated providers on updated policies and processes.
- Conducted monthly meetings to discuss issues and promote digital products.
- Successfully completed yearly projects with Provider Ops ACA RAF Chart Collections.
- Improved denial and edit rates for high-volume accounts by identifying and resolving errors.
Member Services / Tier 2 Sr Health Advisor
United Healthcare
07.2016 - 09.2021
- Supervisor Contingent Escalations team.
- Personal assistance for escalated member issues and special processing.
- Processed claims in real-time while on the phone with members.
- Coached and mentored teammates to improve phone skills and meet performance indicators.
- Participated in multiple UHC events, including the Relay for Life walk-a-thon.
- Maintained a score of 4 or 5 out of 5 on yearly review.
- Kept an NPS scoring of 98%.
- Handled more than 60 daily inbound calls from health plan customers.
- Enhanced overall member satisfaction with healthcare services by providing accessible, timely advice.
- Provided compassionate support to members facing difficult diagnoses or treatment options, alleviating concerns and improving mental wellbeing.
Assistant Manager
Sleep Train / Mattress Discounters
04.2014 - 07.2016
- Managed store operations and sales activities.
- Provided excellent customer service and resolved customer issues.
- Maintained an 88% sale to opportunity percentage.
- 70% of sales were clearing out floor models and old inventory to increase commission rate.
- Maintained a clean, safe, and organized store environment to enhance the customer experience.
- Developed strong working relationships with staff, fostering a positive work environment.
- Monitored cash intake and deposit records, increasing accuracy, and reducing discrepancies.
- Improved customer satisfaction by addressing and resolving complaints promptly.
- Offered hands-on assistance to customers, assessing needs, and maintaining current knowledge of consumer preferences.
- Completed regular inventory counts to verify stock levels, address discrepancies, and forecast future needs.
- Managed inventory levels to minimize stockouts while reducing overhead costs.
- Generated repeat business through exceptional customer service.
- Increased sales through effective merchandising strategies and targeted promotions.
Assistant Manager
Napa Auto Parts
01.2012 - 03.2014
- Oversaw daily operations and inventory management.
- Trained and supervised staff.
- Consistent 10% year over year increase in sales.
- Maintained a clean, safe, and organized store environment to enhance the customer experience.
- Developed strong working relationships with staff, fostering a positive work environment.
- Monitored cash intake and deposit records, increasing accuracy, and reducing discrepancies.
- Oversaw daily cash reconciliations, ensuring accurate financial reporting and minimizing discrepancies.
- Improved customer satisfaction by addressing and resolving complaints promptly.
- Completed regular inventory counts to verify stock levels, address discrepancies, and forecast future needs.
- Managed inventory levels to minimize stockouts while reducing overhead costs.
- Mentored junior staff members in their professional development by offering guidance/support in their assigned roles.
- Generated repeat business through exceptional customer service.
Store Manager
S-Wireless Sprint Retailer
08.2009 - 12.2012
- Managed store operations, sales, and customer service.
- Developed and implemented sales strategies.
- Exceeded all metrics and increased service profits by 15%.
Territory Sales and Support
Verizon Wireless
10.2004 - 06.2009
- Provided sales support and customer service across Northern California.
- Promoted and sold Verizon Wireless products and services.
Territory Sales Representative
Western Powersports
09.2003 - 10.2004
- Supporting existing motorcycle and power products dealerships between Monterey and Redwood City.
- Increased sales with existing accounts and generated additional business by signing up new accounts in the territory.
- Product support and sales at dealer open houses and events.
- Closed highest percentage of consignment deals in California flooring or direct shipping of high dollar products for smaller dealers without space or budgets to buy outright.
- Organized successful promotional events within the territory that drove brand awareness and generated new leads for the company.
- Enhanced product knowledge among customers by conducting informative presentations and demonstrations.
- Optimized route planning for account visits, reducing travel time and allowing for increased face-to-face interactions with clients.
- Boosted sales in assigned territory by developing and maintaining strong relationships with key clients.
Parts Department Manager
Honda Peninsula
02.1988 - 08.2003
- Inventory management and biannual physical inventory, training, scheduling and supervision of 5 employees, purchasing, receiving, partnership with service manager to reach goals, merchandising, working promotional store events at local amateur and professional racetracks to increase store visibility.
Education
General Studies -
Leigh Highschool
San Jose, CA06.1984
Skills
- Document filing
- Document review
- Analytical reasoning
- Client representation
- Interpersonal skills
- Case management
- Creative and critical thinking
- Document management
- Written communication
- Time management
Timeline
Network Program Consultant
West Region Network Analytics Team
05.2025 - Current
Hospital and Facility Advocate
Provider Group Advocate
01.2024 - 04.2025
Member Services / Tier 2 Sr Health Advisor
United Healthcare
07.2016 - 09.2021
Assistant Manager
Sleep Train / Mattress Discounters
04.2014 - 07.2016
Assistant Manager
Napa Auto Parts
01.2012 - 03.2014
Store Manager
S-Wireless Sprint Retailer
08.2009 - 12.2012
Territory Sales and Support
Verizon Wireless
10.2004 - 06.2009
Territory Sales Representative
Western Powersports
09.2003 - 10.2004
Parts Department Manager
Honda Peninsula
02.1988 - 08.2003
General Studies -
Leigh Highschool
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