RYAN SANDOVAL
Geneva,IL
Summary
Operations and client services leader with strengths in workers' compensation, regulatory review, quality assurance, and audit-ready documentation. Known for guiding a 25-person processing team, analyzing service metrics, coordinating across departments, and using research and negotiation to improve outcomes and control medical claim costs.
Overview
17
17
years of professional experience
Work History
Client Program Manager
Enlyte
Remote, IL
03.2020 - Current
- Serve as main client-facing contact for clients, carriers, and internal teams, resolving complex escalations and aligning priorities.
- Lead client performance meetings and turn inventory data trends, KPIs, and service results into recommendations and action steps.
- Coordinated operations, compliance, audit, IT, and offshore teams to execute client strategies and fulfill contractual obligations.
- Supported high-volume client programs and complex claim and operational workflows, ensuring timely and accurate delivery aligned with client and jurisdiction requirements.
- Review operational data and recurring issues to spot trends, remove bottlenecks, and improve turnaround time and service quality.
- Drove workflow improvement efforts that enhanced efficiency and reduced risk.
Medical Cost Reviewer
GENEX Services
Schaumburg, IL
12.2016 - 03.2020
- Reviewed and analyzed workers' compensation claims to ensure compliance with state fee schedules and PPO agreements.
- Interpreted coverage guidelines and jurisdictional regulations to support accurate claim outcomes.
- Coordinated with adjusters and providers to resolve discrepancies and billing disputes, enhancing claim resolution efficiency.
- Maintained documentation supporting audit readiness, compliance, and consistent execution.
- Conducted structured investigations and reviews to support claim accuracy and facilitate cost containment.
EDI Team Supervisor
GENEX Services
Schaumburg, IL
02.2014 - 11.2016
- Led a 25-person team responsible for high-volume insurance data-processing operations.
- Monitored team performance, provided coaching, and ensured adherence to service standards and accountability.
- Conducted performance reviews and quality-assurance meetings, identifying actionable improvement opportunities.
- Organized workflows to enhance productivity and streamline operational efficiency.
Negotiation Specialist
GENEX Services
Schaumburg, IL
05.2009 - 01.2014
- Regularly achieved savings of $10,000 or more per bill through research, analysis, and negotiation.
- Analyzed workers' compensation claims for insurance clients and negotiated cost-effective outcomes with medical providers.
- Researched state legislation and medical-provider cost reports to recommend cost-saving strategies.
- Developed trusted client relationships through clear communication and commitment to results.
Education
Bachelor of Arts (B.A.) - Philosophy
Northern Illinois University
DeKalb, ILSkills
- Client Program Management
- Claims management
- Claims Analysis
- Medical Cost Containment
- Provider Negotiation
- Compliance Management
- Data-Driven Insights
- Performance Metrics
- Quality Assurance
- Process Improvement
- Escalation Management
- Cross-Functional Coordination
- Team Leadership
- Client & Carrier Relationships
Personal Information
Title: CUSTOMER PROGRAM MANAGER | HEALTHCARE
Timeline
Client Program Manager
Enlyte
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
Bachelor of Arts (B.A.) - Philosophy
Northern Illinois University