RAYMOND LABOSSIERE
Bristol,CT
Summary
Dynamic healthcare professional with extensive experience at Optum/United Health Group, specializing in claims quality analysis and operational problem-solving. Demonstrated expertise in Medicare and medical auditing, alongside proficient skills in Microsoft Excel and team training. Successfully optimized workflow processes, resulting in notable enhancements to operational efficiency.
Overview
42
42
years of professional experience
Work History
Claims Quality Analyst Sr
OPTUM / UNITED HEALTH GROUP
01.2010 - 01.2024
- Healthcare Subrogation Audits: Conducted thorough audits of subrogation claims to ensure accuracy and compliance
- Peer-to-Peer training: Facilitated peer-to-peer training sessions to enhance team knowledge and skills
- COVID-19 Response: Played a key role in launching the Test and Trace program during the Covid-19 pandemic
- Evaluated phone calls made by agents
- Tricare Nurse Advice Line Support: Assisted with the Tricare Nurse Advice Line, providing critical support during the Covid-19 pandemic
- COB Claims Audits: Performed detailed audits of Coordination of Benefits (COB) claims to maintain quality standards, Performed focused audits for specific reps as needed
Operations Expert
OPTUM / UNITED HEALTH GROUP
01.2010 - 01.2016
- Workflow and Process Management: Supervised daily activities of staff, managed workflow inventories, and coordinated schedules to maximize efficiency and meet business needs
- Policy and procedure development: Worked closely with documentation for new policies and procedures, and assisted in the development of new processes and programs
- Operational Problem Solving: Identified and resolved operational problems using defined processes, expertise, and judgment, and handled team issues in manager’s absence
- Cross-functional collaboration: Partnered with Sales, Enrollment, Legal and Claims to resolve benefit determination policy and procedural issues and represented Coordination of Benefits (COB) as needed
- Project and Migration Support: Assisted in the Medco pharmacy migration to OptumRx and helped in testing workflows before implementation
Quality, Documentation, and Training Rep
OPTUM / UNITED HEALTH GROUP
01.2009 - 01.2010
- Support the training and auditing of the new hires and maintain the Coordination of benefits (COB) department’s policy and procedures documentations, utilizing Word, Excel, Visio, Outlook and MS Communicator
Coordination of Benefits Senior
OPTUM / UNITED HEALTH GROUP
01.2004 - 01.2009
- Work in the Coordination of benefits (COB) department where I call other insurance companies, benefits administrators, and members for member information to update Oxford’s systems for claims to be processed correctly
- Send stop payment, collections, and reprocessing requests once the system is updated also supported the training and auditing of the New Hires, and maintained the COB department’s policy and procedures documentations, utilizing Word, Excel, Visio, Outlook and MS Communicator
Claims / Reverse and Reprocessing Rep
OPTUM / UNITED HEALTH GROUP
01.1997 - 01.2004
- Reprocessed claims and created customer letters when appropriate
- Facilitated in the training of existing employees on all claims reprocessing protocols
- Coached training classes for new hires
- Fully trained in various specialty queues for claims processing and reprocessing
- Consistently achieved and maintained production and quality standards
- Assist co-workers daily with any claims questions they have
- Worked closely with supervisor and a Connecticut based hospital with outstanding claims issues
Shift Leader of the Automated Statement Rendering Department
FLEET SERVICES CORPORATION
01.1993 - 01.1997
- Duties include prioritizing and allocating work to the operators
- Worked in conjunction with other sections to ensure my department, and the departments after mine, received the work in a timely manner
- Participated in daily meetings with the other shift supervisors to supply updates on the status of the jobs on hand and the jobs that are still expected
- Responsible for the training of the new hires on the operation of all the machines they are to work with
- Worked as a customer service representative in the IRA department
Exchange Service Security
ARMY AIR FORCE EXCHANGE SERVICES
01.1992 - 01.1993
- Responsible for the deterrent of theft from the Base Exchange stores
- Performed inventory control for the high dollar electronic and jewelry departments
Aerospace Propulsion Technician
UNITED STATES AIR FORCE
01.1982 - 01.1992
- Obtained the rank of Sergeant in the United States Air force
- Responsible for a crew of six to eight Airmen
- Evaluated and critiqued the performance of the Airmen on their ability to timely and accurately repair the jet engines
- Trained the new Airmen on the proper repair procedures
- Assisted the testing facility with the certification of the newly repaired engines
- Actively coached my coworkers in their upgrade training
Process Improvement Support Specialist
OPTUM / UNITED HEALTH GROUP
01.2010
- Support the Coordination of benefits (COB) department by defining and verifying ways to improve workflow processes, utilizing Word, Excel, Visio, Outlook and MS Communicator
Education
High school -
Lynn Vocational Technical Institute
Lynn, MA01.1982
Some college courses - Algebra, Pre-Calculus, Psyche 101
Management training course -
United States Air Force
Various classes - Excel, Visio, Six Sigma basics, Problem Solving and decision making, Time Management, Effective Written and verbal Communication, Leadership Course Curriculum
Oxford Health Plans University and United Health Group
Skills
- Pulse
- UNET NICE
- Facets systems
- Dynamic Work Environment
- Medicare Knowledge
- Experienced with Microsoft Word
- Excel Proficiency
- Visio Software Proficiency
- PowerPoint
- Workforce Skill Enhancement
- Operations Management
- Healthcare Claims Expertise
- Medical Auditing Expertise
- Client Interaction Experience
- Assistance in Project Management
- Introduction to Six Sigma Principles
Work Preference
Work Type
Full TimePart TimeWork Location
RemoteOn-SiteImportant To Me
Work-life balanceCompany CultureFlexible work hoursWork from home optionPaid time offPaid sick leave401k match4-day work weekWork Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Timeline
Claims Quality Analyst Sr
OPTUM / UNITED HEALTH GROUP
01.2010 - 01.2024
Operations Expert
OPTUM / UNITED HEALTH GROUP
01.2010 - 01.2016
Process Improvement Support Specialist
OPTUM / UNITED HEALTH GROUP
01.2010
Quality, Documentation, and Training Rep
OPTUM / UNITED HEALTH GROUP
01.2009 - 01.2010
Coordination of Benefits Senior
OPTUM / UNITED HEALTH GROUP
01.2004 - 01.2009
Claims / Reverse and Reprocessing Rep
OPTUM / UNITED HEALTH GROUP
01.1997 - 01.2004
Shift Leader of the Automated Statement Rendering Department
FLEET SERVICES CORPORATION
01.1993 - 01.1997
Exchange Service Security
ARMY AIR FORCE EXCHANGE SERVICES
01.1992 - 01.1993
Aerospace Propulsion Technician
UNITED STATES AIR FORCE
01.1982 - 01.1992
High school -
Lynn Vocational Technical Institute
Some college courses - Algebra, Pre-Calculus, Psyche 101
Management training course -
United States Air Force
Various classes - Excel, Visio, Six Sigma basics, Problem Solving and decision making, Time Management, Effective Written and verbal Communication, Leadership Course Curriculum
Oxford Health Plans University and United Health Group
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