Rachel Dodson
Chambersburg,PA
Summary
Experienced professional seeking a challenging and dynamic career in a competitive and professional environment. Skilled in attention to detail, effective communication, and strong leadership. Committed to finding innovative solutions that improve business practices.
Overview
2
2
years of professional experience
Work History
OON Vendor Negotiation Analyst
United Health Care
- Responsible for the processing, interpretation, and documents business processes, products, services, and software through analysis of data
- Gathers, interprets, and uses complex data to develop actionable steps that will improve processes and optimize results
- Liaising between various business departments and groups
- Analyze cases being sent in for negotiation to see if they are eligible
- Building correspondence daily to be sent out to third parties
- Identifying and validating new data sources
- Working with excel, creating PDF’s, Sending secure emails to providers with decision on their request.
Interm Supervisor
United Health Care
- Responsible for coordinating the employees of a department or division
- Setting goals for performance and deadlines in ways that comply with company's plans and vision
- Organizing workflow and ensuring that employees understand their duties or delegated tasks
- Monitoring employee productivity and providing constructive feedback and coaching.
Health Advocate tier 2
United Health Care
01.2017
- Worked with members to educate and better understand their plans
- Worked with internal and external business partners to meet MBOs
- Able to provide real-time resolution to our members through simple and complex claims processing
- Assisted supervisor with coaching and mentoring of team members who were struggling to meet expectations.
Call Coach
United Health Care
08.2016 - 01.2017
- Assisted in the classroom with the trainer for our new hires
- One-on-one coaching sessions
- Call Monitoring, NPS monitoring and call backs, taking escalations for the classroom, Teaching material, entering metrics for all agents and observations and having those ready for management to observe during meetings
- Taking live calls for agents to observe.
Benefit Advocate tier 1
United Health Care
06.2015 - 08.2016
- Assisted with inbound calls for open enrollment, benefits, basic claims questions, authorization and appeal status
- Place third party calls to providers to get issues resolved for our members
- Assist with choosing the correct benefit plan for them during open enrollment
- Offering programs that come free with our health plans to help member’s live healthier lives.
Education
Skills
- Credit bureau reading
- Judgmental credit decision
- Manager escalated calls
- Interm supervisor
- Skip tracing (Lexis nexus, innovis, KIQ)
- High organization and training skills
- Verbal communication
- Written communication
- Underwriting
- Group lead skills
- Claims reprocessing
- Call auditing
- Claims and benefit expert
- Microsoft Word
- Microsoft Excel
- Microsoft Outlook
- Microsoft Publisher
- Microsoft Power Point
- Dos
- Main Frame
- Nice Recording System
- Unet (macros)
Additional Information
I have 6 years of medical claim history. Reading, analyzing, and processing claims. Organizing workflow and ensuring that employees understand their duties or delegated tasks. Monitoring employee productivity and providing constructive feedback and coaching. I have experience in Commercial, Medicare, reimbursement programs and cost savings. I have excel, access, unet, iset, cdb, ndb experience. I work with quality, NPS, RISE, and RTA.
Awards
- Top quality award x4
- Star player award x4
- Customer delight rewards x2
- Service Hero 2017
- Service Hero Winner 2021
References
Debra Hampton, 240-405-2253, Supervisor, Mike Collinson, 304-995-7195, Manager, Chantel Wims, 240-586-9645, Friend, Friend, 240-469-8402, Friend, Eric Williamson, 717-830-2416, Friend
Timeline
Health Advocate tier 2
United Health Care
01.2017
Call Coach
United Health Care
08.2016 - 01.2017
Benefit Advocate tier 1
United Health Care
06.2015 - 08.2016
OON Vendor Negotiation Analyst
United Health Care
Interm Supervisor
United Health Care