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MICHAEL R. DE SILVA
Pearl City,USA
Summary
Results-driven professional with expertise in operations and customer service. Demonstrated success in claims processing and contract management, enhancing team performance and service quality. Proven ability to oversee compliance and strategic communication across diverse industries, driving sales growth and improving customer satisfaction.
Overview
16
16
years of professional experience
Work History
Claims Administrator - Life Policies and Annuities
Pacific Guardian Life
02.2025 - Current
- Processed claims, calculating benefits payout, applicable Federal and State tax withholding, and policy interest for Life and Annuity claims to ensure compliance and accuracy.
- Adjudicated and processed death claims, ensuring accurate and timely resolutions for beneficiaries.
- Authorized and processed fund releases, facilitating prompt access to benefits for beneficiaries.
- Legal claim eligibility and beneficiary verification.
- Understanding and working with contracts, estates, and trusts.
- Preparing applicable tax forms such as 1099-R and 1099-INT.
Customer Service Representative
Pacific Air Cargo
01.2023 - 09.2024
- Delivered accurate sales quotes, facilitating customer decision-making.
- Prepared invoices, collected and released inbound freight to streamline cargo processing.
- Ensured compliance with state and federal agricultural and homeland security laws, safeguarding operations.
- Managed all aspects of cargo handling for inbound and outbound freight.
- Prepared departure documents for freight on multiple Alaska Airlines flights.
- Bumped cargo to optimize space during loading.
- Collaborated with various federal, state, and local agencies.
- Collected various fees, including taxes and freight.
Network Management Representative-Provider Relations
WellCare/Ohana Health Plans
09.2019 - 12.2019
- Contracted and credentialed new providers to align with Ohana Health Plans for Medicare Parts ZAB, ZMD, ZMR, and ZBH, enhancing network accessibility.
- Compiled application packages, verified provider credentials, and ensured compliance with licensing requirements in Hawaii, supporting quality care delivery.
- Managed provider information and streamlined processes using Salesforce, Assist, and Cactus software, improving data accuracy and operational efficiency.
- Reviewed their curriculum vitae for employment gaps and requested explanations for gaps exceeding five months.
- Providers include, but are not limited to, primary care physicians, specialists, physician hospitalists, and primary caregivers.
- Facilities include doctors' offices, long-term care facilities, foster homes, and ambulatory services.
Public Engagement Representative
St Francis Healthcare System of Hawaii
01.2019 - 02.2019
- Engaged public through organized events, personal contact, social media, and mainstream media, raising awareness about different blood cancers.
- Raised public awareness through events like the Marianne Cope Walk organized by St. Francis, Access Surf’s Teaching the Handicapped to Surf event, and the University of Hawaii’s donor drive.
- Organized corporate events and raised awareness for companies through engaging PowerPoint presentations and direct interaction.
- Leveraged social media platforms like Twitter, Facebook, and Instagram to expand audience reach.
Membership Service Advocate
HMSA Blue Cross/ Blue Shield
03.2014 - 04.2018
- Managed patient and client relations for employer-sponsored medical plans, federally funded Affordable Care Act, and Hawaii State EUTF plans, ensuring high levels of satisfaction and retention.
- Average first call resolution (FCR) is 80% or higher, with a resolution satisfaction rate of 90 to 100%.
- Well-versed in HMSA’s plan offerings, employer-sponsored and individual plans, and federally sponsored marketplace plans.
- Established One Call, HMSA’s membership services call center, streamlining member outreach and support.
- Recovered $546,924.47 for HMSA through a take-back arrangement with Kapiolani General and Tricare, enhancing financial accountability.
- Conducted eligibility verification to facilitate claims processing and member enrollment.
- Received recognition through many Mahalo Grams and letters of appreciation from members and group leaders.
- Experienced with LRSP, QNXT, and HMSA Enroll.
- Worked with various software including CRM, Benefit Focus, QNXT, Waypoint, EPS.
- Used my knowledge and expertise to set up Time Warner’s call center in Ontario, Canada.
- Shared my expertise and knowledge of PBX (private branch exchange) data with management.
Consultant, campaign organizer
Governor Abercrombie
11.2012 - 11.2014
- Managed call center operations, led campaign promotions, trained volunteer staff to enhance outreach effectiveness.
- Conducted voter outreach, recorded constituent feedback to inform campaign strategies.
- Utilized tools such as social media blogging, school, and college visits to engage the younger voter-eligible audience.
- Prepared weekly scripts for call center representatives, ensuring consistent messaging during voter outreach.
Director of Field Operations- Hawaii and Nevada
Barack Obama Presidential Campaign
Honolulu, USA
06.2010 - 11.2012
- Conducted voter outreach and documented constituent feedback to enhance community support in Hawaii and Nevada.
- Managed campaign call center during elections and trained representatives to improve voter outreach effectiveness.
- Engaged media to amplify campaign events and increase public visibility.
- Campaign promotions, such as public speaking events and volunteer recruitment efforts.
- Organized campaign tours, mall events, and promotions.
- Kept daily and weekly voter statistics and feedback using a voter CRM system.
- Prepared weekly scripts for telephone operators during campaign periods.
- Used social media and blogging to reach the younger voter-eligible audience.
Education
BSc. - Business Administration – Green and sustainable energy
Liberty University
Lynchburg, VA12-2027
Associate Business Administration -
Toronto School of Business
Toronto, Ontario, Canada06-1998
Skills
Claims processing
- Policy administration
- Contract management
- Collective bargaining
- Customer service
- Effective communication
- Data analysis
- Public speaking
- Social media engagement
- Customer relationship management
- Event coordination
- Financial reporting
- Microsoft office
- Compliance verification
- Carrier coordination
- Policy interpretation
- Claims auditing
- Document preparation
- Time management abilities
- Presentation skills
- Staff supervision
- Collaboration and teamwork
- Teamwork
- Contract review
- Professional demeanor
- Notary public
- Communications drafting
- Analytical thinking
Training
- Compliance Training: Certified in Fraud and Waste Management
- Customer Service Management & Customer Relationship Management (CRM)
- Confidential Medical Information Handling (CMI)
- Health Insurance Portability and Accountability ActHIPAA
- Labor relations: collective bargaining, grievances, and arbitration.
- Conflict management.
- Dale Carnegie training.
- Computer training: Sales Force, Microsoft Word, PowerPoint, Excel, Access, Outlook, Adobe, Nero, Mainframe programs (LSP, LRSP), CRM, Benefit Focus, QNXT, Waypoint, EPS, Cactus, GIAS.
- QUALITY: JIT, TQM, ISO 9000-9002.
Awards
Numerous awards and recognitions for customer service and sales.
Industries
- Annuities and Life Claims Adjudication
- Customer service
- Call center operations
- Health insurance claims and administration/enrollment
- Operations management
- Quality control
- Auditing
- Training
- Onboarding
Affiliations
- Active Polo player and Private pilot. Loves hiking, debating, and public speaking.
Accomplishments
- Numerous customer service recognitions and awards.
Timeline
Claims Administrator - Life Policies and Annuities
Pacific Guardian Life
02.2025 - Current
Customer Service Representative
Pacific Air Cargo
01.2023 - 09.2024
Network Management Representative-Provider Relations
WellCare/Ohana Health Plans
09.2019 - 12.2019
Public Engagement Representative
St Francis Healthcare System of Hawaii
01.2019 - 02.2019
Membership Service Advocate
HMSA Blue Cross/ Blue Shield
03.2014 - 04.2018
Consultant, campaign organizer
Governor Abercrombie
11.2012 - 11.2014
Director of Field Operations- Hawaii and Nevada
Barack Obama Presidential Campaign
06.2010 - 11.2012
BSc. - Business Administration – Green and sustainable energy
Liberty University
Associate Business Administration -
Toronto School of Business