Raymond Rodriguez Jr.

I run a crew of 3 to 7 employees on a nightly basis. We power wash commercial restaurant equipment. During a normal day, we will drive to several locations throughout the city, up to 2 hours away. We will arrive, set up the job, clean the commercial vent hoods, and inspect them to meet state and city regulations. As a supervisor I am in charge of setting up the Project interacting with the Customer, then completing the project and assuring our services are the up to the High Standards set forth by our company.

• I am currently employed by United Health Group as an Appeal Coordinator for DSNP policies.
• I have been employed for the past 17 years by United Health Group.
• I started as a customer service representative and was previously a Tier 2 Rep in the Advocate4ME model.
• I have assisted in training new hire classes and also have been a 'coach' in the classes for UHC.
• In previous roles I have taken calls in the range of 50-75 a day explaining member benefits and medical claims.
• My previous position encompassed the same amount of calls and criteria but I paid and processed medical claims up to an amount of $780.00.
• I have the role of processing claims that are wrong or we are able to fix in order to speed up and enhance the customer experience and preventing further distress or call backs that can be prevented by the processing of a claim live on the call.
• A Tier 2 customer service rep was unlike the normal role because I paid claims on the phone while the member was on the call.
• This role required us to know medical coding and billing in order to perform our job.
• In my position we dealt with money and payments on a daily basis, we must be very detail oriented as we are constantly audited for errors and overpayments.
• I am required to follow standard operating procedures and also use my own knowledge in order to determine the outcome of the claims.
• I am currently a Medicare appeals and grievance coordinator a role that I have been in for the past few years.
• In this position I handle member appeals and non-participating provider appeals for Medicare supplements of UHG.
• It involves making a decision on the appeal along with obtaining all information required to move forward with said appeal.
• I will make outreaches to members and providers to obtain all information that the case needs such as medical records and general information for the case.
• I also am in direct contact with Provider medical groups that we are required to reach out to for information that they have such as claims and contract statuses for the group that are not in our system.
• Once all information is obtained I follow Medicare guidelines along with the plans evidence of coverage in order to make a decision on the appeal such as overturn and pay or uphold or dismiss the appeals.
• We are required to keep strict Medicare guidelines and adhere to the strict time frames to stay in compliance.
• I am looking to expand my expertise and knowledge within the field in which I have over 17 years of experience.

• I tutor middle school children and help them with general issues and questions.
• I work for a college prep program called AVID(ADVANCEMENT VIA INDIVIDUAL ACHIEVEMENT), which helps prepare students for college.

• I am directory assistance for sprint and other major phone companies.
• I take an average of 500-800 calls per 8 hr shift.
• This is a very fast paced and team oriented job.

• Company Overview: Insurance
• Member service representative assisting members in adjusting their auto insurance policies.
• I also helped with questions about coverages and policies with auto insurance.
• I serviced auto policies only.
• Insurance

• Received incoming calls for orders, placed orders and handled any questions for the customer.
• Very fast paced, and team oriented.

• Company Overview: Hotels and Lodging
• I was a cook at the hotel golf grill.
• I handled most kitchen responsibilities such as cooking and cleaning the line.
• These included prepping and food handling.
• Hotels and Lodging