Rosemary Cimino

• Review, process, and respond to billing and quality-of-care grievances regarding MetLife network providers, ensuring timely and satisfactory resolutions
• Produce detailed daily and monthly reports on dental grievances and complaints for inventory and tracking purposes
• Assist SafeGuard DHMO with their member grievances and provider appeals
• Managed all TRICARE MetLife complaints and network provider grievances, successfully overseeing operations from2011 to the contract's conclusion
• Handled high-profile dental complaints, including those submitted through the Better Business Bureau, state insurance agencies, Attorney General, congressional and presidential offices
• Advanced proficiency in all dental claims and provider-related systems

Key Achievements:

• Improved resolution efficiency and client satisfaction by streamlining grievance handling processes.
• Play a critical role in maintaining provider and client relationships through effective issue resolution.
• Improved interdepartmental communication, ensuring timely updates on case progress and resolutions.
• Enhanced grievance resolution rates by implementing efficient tracking and monitoring systems.
• Communicated effectively with diverse clientele, demonstrating empathy and professionalism in addressing their grievances.
• Served as a subject matter expert with other departments including Call Center Huddle Hops, providing clarity on the PDP grievance process when required.
• Established positive relationships with internal departments, enhancing cooperation when resolving cross-functional grievances.

• Analyzed, researched, and maintained provider payment files for dental claims with high accuracy
• Led several projects and processes while mentoring and training team members
• Gained comprehensive knowledge of all systems related to dental provider issues
• Key Achievements:
• Recognized for leadership and ability to train peers effectively
• Developed comprehensive training materials for new analysts, improving onboarding efficiency.

• Processed dental claims with a strong understanding of dental terminology, plan provisions, and claims systems
• Assisted then transitioned seamlessly to the Provider Control Unit based on performance

• Enrolled and processed life insurance policies for group contracts, maintaining direct communication with members, company contacts, and account representatives
• Served as team lead during the integration of John Hancock’s group policies
• Key Achievements:
• Played a vital role in the successful onboarding of acquired group policies
• Reduced administrative burden by automating routine tasks within the group insurance department.

• Gained expertise in dental terminology and plan provisions while processing dental claims efficiently and accurately.

• Processed Statements of Health for life insurance, utilizing a solid understanding of medical terminology and plan provisions.