Michelle Cavazos
Plainfield,IL
Summary
Motivated and results oriented individual desiring a claims supervisor position with a fast paced health organization where my skills and experience in high volume claims will be of value.
Overview
19
19
years of professional experience
Work History
Contract Specialist
JDA Ehealth @ Parathon
Naperville, IL
05.2016 - Current
- Clarified contract terms to optimize vendor interactions and maintain compliance with established policies.
- Optimized contract review and approval workflows, significantly improving overall efficiency in operations.
- Evaluated contracts for consistency, accuracy, and alignment with organizational objectives and regulatory standards.
- Work on Medicare, Medicaid or Commercial contracts to analyze coverage and reimbursement specifics and build this information into the database.
- Streamlined response facilitation for inquiries, ensuring satisfaction and adherence to healthcare standards.
- Developed and implemented training programs for new employees focused on customer service protocols, ensuring uniformity in service standards.
- Ensured timely fulfillment of contractual requirements by closely monitoring progress and addressing potential issues proactively.
- Established trust with clients through consistent follow-up on commitments made during meetings or calls.
Team Lead
Kohls
Joliet, IL
05.2023 - 10.2025
- Processed customer transactions accurately and efficiently using point-of-sale systems.
- Managed cash drawer, ensuring balance and adherence to cash handling procedures.
- Assisted customers with inquiries, providing exceptional service and promoting loyalty programs.
- Trained new cashiers on operational procedures and customer service best practices.
- Resolved customer complaints promptly, fostering positive relationships and enhancing customer satisfaction.
- Monitored inventory levels, assisting in restocking shelves and maintaining product displays.
- Greeted customers entering store and responded promptly to customer needs.
- Operated cash register for cash, check, and credit card transactions with excellent accuracy levels.
- Counted money in cash drawers at beginning and end of shifts to maintain accuracy.
Senior Key Account Representative
Multiplan Inc.
Naperville, IL
11.2007 - 05.2016
- Investigate, resolve and respond to patient, provider and or client medical claims inquiries.
- Ensure compliance with contract administration, demographic maintenance, and service level requirements through claim review and client appeals.
- Supports business goals & system fixes by claim review, analyzing, identifying and resolving issues.
- Skilled to manage time and handle competing priorities in a multi-task, multi-process and multi-program environment.
- Monitor and report claims trend information and claim database configuration objectives.
- Maintain standard custom reporting for Client on weekly bases and able to control the Turnaround time per the client's requirement.
- Act as team resource in the absence of Team Leader and able to manage 30 staff members.
- Work directly with provider in the negotiation of timelines, payment provisions, and targets claim resolution sources. Communicate directly and participate in conference calls with Clients, account managers, contractors and providers.
- Serve as mentor and subject matter expert to staff, providing support as needed to other team members to ensure that related correspondence, turnaround reporting, repricing and claims or appeal adjustment meet applicable deadlines.
- Creates, maintains and utilize job aids to support training efforts and provide trainee with applicable reference materials, job aids may include but not limited to instructor guides, presentation slides, visual aids props and detailed scenarios.
- Review quality audits to ensure accuracy and no representative are below a 98% or below. Communicate results to team members including retraining when necessary. Identify trends, and works with team members to ensure all workflows are followed and understood. Assist with training and mentoring of new employees. Including retraining and some classroom training as needed.
- Develop, and evaluate staff to ensure the efficient operation of department.
- Develops and maintains policies and procedures, as necessary.
- Collaborate, coordinate, and communicate across disciplines and departments.
- Efficiently and accurately handled high priority escalations expeditiously.
Education
Associate in Applied Science Degree - Paralegal
Northwestern Business College
Bridgeview, IL06-2005
Paralegal Externship - undefined
Cook County Public Defender
Bridgeview, IL04-2005
Skills
- Microsoft Word, Microsoft Excel, Power Point, Microsoft Outlook
- West law, Nexus-Lexis
Timeline
Team Lead
Kohls
05.2023 - 10.2025
Contract Specialist
JDA Ehealth @ Parathon
05.2016 - Current
Senior Key Account Representative
Multiplan Inc.
11.2007 - 05.2016
Paralegal Externship - undefined
Cook County Public Defender
Associate in Applied Science Degree - Paralegal
Northwestern Business College