Marvin Gustave
Miami Lakes,FL
Summary
Results-oriented Analyst skillful in managing and breaking down large volumes of information. Effective medical claims processor with strong background building rapport with providers to discuss claim status or claim denials. Driven performer equipped to handle multiple administrative tasks effectively. Exemplary worker with highly investigative skills when processing claims.
Overview
8
8
years of professional experience
1
1
Certification
Work History
Appeals and Grievance Analyst
Point32Health
11.2022 - 07.2024
- Serve as primary analyst of managed care information, such as health plan specific policies, to internal departments
- Coordinate resolution results and relay investigative results with all involved parties
- Review inquiries to determine if they meet definition of appeal/grievance
- Analyze payment data related to client manage care contracts to ensure payor compliance
- Participate in workgroup meetings to address trends in appeals and grievances and to work on process improvement initiatives
- Request and review all related relevant documentation and assemble case file
- Research and resolves all appeals and any correspondence in clear and concise written form, maintaining compliance with state and federal time frames and requirements
- Consistently meet established completion times for projects and assignments
Call Center Supervisor
Chewy
02.2019 - 11.2022
- Serve as the point of contact for escalated customer service issues and identify solutions to maintain service level goals and ensure customer satisfaction
- Meet the performance goals established for the position in the areas of: efficiency, call quality, provider satisfaction, first call resolution and attendance
- Answered and resolved 100+ inquiries daily from customers nationwide
- Provide coaching and training to team members to build a collaborative work culture centered on communication protocols, customer service standards, de-escalation techniques and product knowledge
- Managed a team of 35+ customer service representatives for a high volume call center, which included coordinating daily operations and scheduling to resolve issues with billing disputes, insurance coverage, claims, account logins, and customer service issues
- Provide upper management with statistical performance reports and plans for improvement related to customer service department monthly
Team Manager
Preferred Service
12.2016 - 01.2019
- Proactively assisted residents and their guest with a wide range of requests, from restaurant recommendations to arranging transportation, to enhance their overall experience
- Handled resident complaints and emergencies with professionalism and resolve, ensuring residents satisfaction and comfort
- Answers phone calls, emails, and in-person inquiries promptly and provides accurate information
- Provided personalized concierge services to high-profile residents, ensuring their needs and requests were promptly and efficiently met, with high degree of respect for privacy
- Developed and implemented training programs to ensure team members were equipped with the necessary skills to uphold a professional appearance and demeanor at all times, providing residents the highest level of customer service
- Collaborated with parking attendants and building staff to maintain a smooth and organized valet parking system for residents
Education
Associate Degree in Business Administration -
Broward Community College
Pembroke Pines, FL12.2019
High School Diploma - undefined
North Miami Senior High
North Miami, FL06.2017
Skills
- Training and Development
- Conflict Resolution
- Regulatory Compliance
- Report Preparation
- Relaying Complex Information
- Evidence-Based Decision Making
- Customer Service
- Project Management
- Computer Software
- Data Analysis
- Team Management
- Trend forecasting
- Policy Interpretation
- Claims analysis
- Liability Determination
Certification
- Licensed Life and Health Insurance Agent
Timeline
Appeals and Grievance Analyst
Point32Health
11.2022 - 07.2024
Call Center Supervisor
Chewy
02.2019 - 11.2022
Team Manager
Preferred Service
12.2016 - 01.2019
Associate Degree in Business Administration -
Broward Community College
High School Diploma - undefined
North Miami Senior High
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