OYDIN ABDUSAMATOVA

UnitedHealth Group – Remote

Supervisor, Escalations (SG25 CUS047) | May 2025 – Present

• Promoted from Resolution Support Specialist to Supervisor, Escalations, in recognition of strong performance and leadership.
• Lead and mentor a team of escalation specialists, ensuring complex member issues are resolved in alignment with UnitedHealth Group’s mission to help people live healthier lives and make the health system work better for everyone.
• Manage escalated cases from Tier 1 and Tier 2, providing guidance on resolution strategies and supporting employees in handling sensitive or high-impact situations.
• Partner with cross-functional departments to identify process improvements that enhance member experience and operational efficiency.
• Maintain compliance with company policies, healthcare regulations, and quality standards while meeting performance metrics and service-level goals.
• Contribute to annual performance reviews, team development, and coaching to support professional growth and high employee engagement.

• Company Overview: Resolution Support Specialist (RSS) extensive experience handling appeals and prior authorization cases in collaboration with doctors specialists, and nurses
• I work directly with medical professionals to resolve authorization issues, ensuring timely and accurate decision-making.
• Additionally, I assist with claims resolution by investigating the reasons for claim denials, analyzing details of the claims, and facilitating disputes to ensure accurate processing.
• My responsibilities also include collaborating with various healthcare providers to address complex cases, ensuring a smooth resolution process for all involved parties.
• Specialize in claims research, billing disputes, benefits issues, and resolving tier-specific problems.
• Collaborated with doctors and nurses to resolve claims and prior authorization issues, ensuring timely approvals.
• Work with Tier 1 and Tier 3 teams to ensure timely and accurate resolution of complex issues such as NPOP and Loss of Part B reinstatements.
• Support Tier 1 advocates through coaching and assistance, leveraging my subject matter expertise.
• Consistently meet or exceed departmental metrics, providing exemplary service while managing a high caseload.
• Resolution Support Specialist (RSS) extensive experience handling appeals and prior authorization cases in collaboration with doctors specialists, and nurses

• Worked in a high-volume ACD environment while adhering to all workforce guidelines.
• Assisted members during specific election periods, providing exceptional customer service regarding plan benefits, provider information, billing, and enrollment.
• Helped members make informed decisions about their healthcare plans, ensuring satisfaction and retention during critical times in the enrollment process.
• Collaborated with other departments to resolve complex member issues, consistently meeting or exceeding all performance metrics.

• Answered incoming calls in a fast-paced ACD environment, addressing inquiries related to Medicare Advantage plans, provider information, claims, and billing.
• Became a Subject Matter Expert (SME) in Medicare Advantage Plans and proficient in UHC systems (MAESTRO, MARX, ICUE, VIEW, DOC360, KNOWLEDGE CENTRAL).
• Assisted members in making informed decisions about their healthcare, consistently exceeding service expectations and metrics.

• Company Overview: Transportation Provider for UnitedHealthcare
• Managed incoming calls in a fast-paced ACD environment, adhering to workforce guidelines.
• Scheduled and dispatched transportation, including independent drivers, wheelchair vans, and ambulance transport, ensuring timely completion.
• Acted as a liaison between transportation providers and healthcare facilities, resolving issues and ensuring high-quality service.
• Met and exceeded all monthly metrics.
• Transportation Provider for UnitedHealthcare