Peter Wright
Orlando,FL
Summary
Efficient, reliable, dependable, organized, detail-oriented, deadline-driven Healthcare Specialist with a passion for health and wellness, writing, editing, researching, analyzing, problem-solving, coaching, and public speaking, Attention to detail. Detail-oriented with a significant background working closely with employees to survey needs, identify issues and implement corrective actions. Dedicated to accuracy and making long-term changes in workplace.
Overview
12
12
years of professional experience
Work History
Appeal and Grievance Coordinator
Clear Spring Healthcare Insurance
Miramar, FL
01.2022 - Current
- Effectively addressing various grievances from Medicare beneficiaries promptly, while adhering to the various regulations and guidelines of Medicare.
- Communicate tactfully with various internal departments and external partners via emails or phone calls to gather the necessary information that is needed to create various reports, case notes, and resolution notes.
- Accurately analyzing various information about members' accounts and various activities involving the members, and creating a conclusion that would address the needs of the members.
- Creating various grievance case notes that are highly detailed and accurate, which are reflections of events on the members’ accounts.
- The creation of these notes is formulated within the compliance of Medicare rules and guidelines.
Member Service Representative (Escalation Team)
Clear Spring Healthcare Insurance
Miramar, FL
01.2021 - 01.2022
- De-escalating any issues with Medicare beneficiaries' eligibility, with their Medicare Part D plan, and with their Medicare Advantage Plan.
- Accurately explain members' Medicare benefits and the insurance benefits that are associated with their plan in a detailed and concise manner.
- Utilizing the Marx or CMS database to provide billing information to members and accurately informing members of their Low-Income Subsidy status, Late Enrollment Penalty, Special Election Period options, Disenrollment process, and cancellation process, which are fully adhered to the rules and guidelines of Medicare.
- Accurately provide detailed and concise information about the health insurance plan during the Medicare Annual Enrollment Period (October 15 to December 7) to prospective members and current members.
- Process applications with prospective members for the Health Insurance Part D Plan.
Customer Service Representative
Capital One
Hollywood, FL
01.2020 - 01.2021
- Interact with Capital One’s customers, and provide detailed and accurate information on credit transactions, investigate if transactions are based on fraud, and transfer to the appropriate department.
- Explain in detail ARP, residual interests, memberships, and other fees that are impacting the customers' accounts.
- Assist customers in paying over the phone, or refer customers to the secured website for payment.
- Utilization of consistent learning tools that are distributed digitally to ensure that information is updated accurately and the company’s guidelines are followed.
- Exceeded established service goals while leveraging customer service, sales and employee management best practices.
Physician Support Specialist
MDVIP, -Inc.
Boca Raton, FL
01.2013 - 01.2019
- Responded professionally to service inquiries and requests from MDVIP physicians, office staff, and members.
- Successfully creating FSA appeal documents, sending mailings, and creating correspondence to members by mail.
- Proactively identify issues that create a substandard service experience, and provide management with the tools to create possible solutions.
Education
Cyber Security Analysis Certificate -
Google
01.2025
Masters of Science - Healthcare Administration
Purdue University
West Lafayette, IN04.2019
Bachelor of Science - Business Management
Touro College and University System
Brooklyn, NY06.2012
Skills
- Python
- SQL
- Linux command-line
- NIST CSF
- CIA Triad model
- SIEM tools
- Packet sniffers
- Microsoft Office
- InContact
- Salesforce
- Avaya
- Written communication
- Computer system administration
- Typing
- Word processing
- Med Hok
- MARX
- MP Web
- Genysis
Highlightedqualification
Efficient, reliable, dependable, organized, detail-oriented, deadline-driven Healthcare Specialist with a passion for health and wellness, writing, editing, researching, analyzing, problem-solving, coaching, and public speaking, Attention to detail.
Affiliations
- Build computers
- Write Stories
Timeline
Appeal and Grievance Coordinator
Clear Spring Healthcare Insurance
01.2022 - Current
Member Service Representative (Escalation Team)
Clear Spring Healthcare Insurance
01.2021 - 01.2022
Customer Service Representative
Capital One
01.2020 - 01.2021
Physician Support Specialist
MDVIP, -Inc.
01.2013 - 01.2019
Cyber Security Analysis Certificate -
Google
Masters of Science - Healthcare Administration
Purdue University
Bachelor of Science - Business Management
Touro College and University System
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