Ryan Sandoval
Geneva,IL
Summary
Talented Account Manager with over 15 years of demonstrated excellence in the Workers Compensation insurance industry. Skilled in Client Services, Workers Compensation, Project Management, Business Process Improvement, and Issue Resolution
Overview
15
15
years of professional experience
Work History
Client Program Manager
MITCHELL INTERNATIONAL
03.2020 - Current
- Drives client satisfaction,communication and contributes to the overall management of the client relationship.
- Manage inventory – thousands of medical bills, both workman’s compensation and auto accident claims
- Maintain compliance with TAT guidelines differing with different jurisdictions to avoid fines/penalties
- Manage offshore auditing teams
- Hold daily meetings to go over any issues, present projects, offer daily processing solutions and quality assurance
- Complete / Present daily, weekly, and monthly inventory reports to client
- Handle client initiated escalations, investigating issues and providing quick solutions
- Increased client satisfaction by effectively managing multiple program portfolios and ensuring timely delivery of projects.
- Improved project efficiency by streamlining communication channels between various stakeholders, including clients, vendors, and internal teams.
- Conducted regular performance reviews with team members to ensure continuous improvement in service quality and client satisfaction.
Medical Cost Reviewer
GENEX SERVICES
12.2016 - 03.2020
- Analyze and review workman’s compensation claims in order to reduce cost to insurance companies providing the coverage to the injured employee
- Use software to determine state fee schedules and also apply PPO Networks to reduce total amount owed on each claim to medical providers
- Work closely with adjusters to accommodate special requests
- Had to be approved by two clients, based on experience/work record, in order to review their bills/handle requests
- Handling of appeals from medical providers requesting additional payment
- Conducting research to determine if additional funds are appropriate.
EDI Team Supervisor
GENEX SERVICES
02.2014 - 11.2016
- Responsible for a team of 25 employees working data entry positions
- Led quality assurance meetings with groups as well as individuals
- Maintained great ongoing client relationships by meeting their standards.
- Organized work models to achieve maximum productivity.
- Enhanced team productivity by implementing efficient workflow processes and monitoring daily progress.
- Developed a cohesive team environment through regular communication, collaboration, and constructive feedback.
Negotiation Specialist
GENEX SERVICES
05.2009 - 01.2014
- Analyze workman’s compensation claims for insurance clients to negotiate a fair and equitable outcome for both medical provider and client
- Tracked record of major accomplishments delivering results of increased revenue and cost savings
- Regularly achieved savings of $10,000 or more per bill by researching state legislation, reviewing medical provider cost reports, and crating assertive proposals to achieve desired outcome
EDI Resolution Specialist
GENEX SERVICES
02.2009 - 05.2009
- First position at Genex Services
- Data entry selecting correct service and remittance addresses of medical providers from physical bills to the bill review system
Education
Bachelor of Arts in Philosophy -
Northern Illinois University
DeKalb, ILSkills
- Salesforce
- SmartAdvisor
- Account Management
- Client Relationship Building
- Time Management
- Multitasking
- Project Implementation
- Training
- Resource Allocation
- Quality Assurance
- Customer Relations
- Root Cause Analysis
- Data Collection & Research
Timeline
Client Program Manager
MITCHELL INTERNATIONAL
03.2020 - Current
Medical Cost Reviewer
GENEX SERVICES
12.2016 - 03.2020
EDI Team Supervisor
GENEX SERVICES
02.2014 - 11.2016
Negotiation Specialist
GENEX SERVICES
05.2009 - 01.2014
EDI Resolution Specialist
GENEX SERVICES
02.2009 - 05.2009
Bachelor of Arts in Philosophy -
Northern Illinois University
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