Samantha Cuglietta-Healy
Colmar,PA
Summary
Organized and dependable candidate successful at managing multiple priorities with a positive attitude and proven outcomes. Willingness to take on added responsibilities to meet team goals. Strong analytic skills understanding consumer patterns and preferences. Self motivated with established remote work skills.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Licensed Health Insurance Agent
Self Employed
10.2014 - Current
- Performed needs analysis with clients to make appropriate health insurance product recommendations.
- Effective communication through email and phone with high volume 75+ weekly during open season. While also maintaining email campaign to book of business using Constant Contact.
- Used enrollment software for online applications through insurance company and Marketplace. Adaptable to learning new processes and updates yearly.
- Liaison for client needs between insurance company and government Marketplace with strong ever changing compliance knowledge.
- Yearly education for licensing, new products, and tax credit changes.
- Understanding changing insurance needs to obtain and retain clients.
- Obtaining and recording consent consistent with compliance.
- Liaison for client needs between insurance company and government Marketplace.
- Review reports and analytic data to understand and foresee yearly client needs with changing products offered.
- Maintain LLC filings and paperwork.
Social Services Specialist
Baycare Health Systems
02.2013 - 12.2014
- Cultivated positive, trusting relationships with patients and community providers to promote effective coordination of resources.
- Gathered information from mental and physical health to make recommendations and determine appropriate care plans during intake.
- Self-motivated as sole ER Social Service Specialist
- Generate reports using Diver program to provide fact-based analytics for department then present within department weekly and hospital wide monthly. Required in part to maintain grant.
- Liaison between hospital and Department of Children and Families.
- Attend monthly networking meetings to collaborate with other like resources and keep our community presence known while streamlining access for clients in need.
- Use analytic data to identify recidivism then set and implement plans to reduce recidivism.
- Provide educational meetings to ER doctors and nurses on new programs, updates, and available assistance for patients.
Case Management Assistance
Baycare Health Systems
11.2011 - 03.2014
- Review Medicare denials and present case for appeal using fact based medical records.
- Attended regularly scheduled case management and staff meetings to connect real patient needs verse insurance requirements.
- Write multiple appeal daily based on medical evidence in reviewed records to prove eligibility for payment in accordance with Medicare guidelines.
- Use Diver program to run reports showing analytic information for department head to present at interdisciplinary meetings.
- Review surgery schedule to ensure appropriate admission status in effort to avoid denials.
- Run analytic reports and review to identify patterns for recidivism as well as Medicare denials.
- Effective communication by phone and email within company and connecting with discharged patients.
Education
Bachelor of Science Psychology and Cert in Behavioral Forensics -
University of Central Florida
Orlando, FL08.2010
Skills
- Data analytics
- Inbound communications management
- Market data collection and analytics
- Conflict resolution
- Effective prompt communication
- Office Suite
- Highly organized and self motivated
- Effective task management
- Policy and regulation analysis
- Client retention
- Compliance knowledge
Certification
- Licensed Health Insurance Agent
- Mandated reporter training
- Training classes completed for Microsoft Suite including Excel
Timeline
Licensed Health Insurance Agent
Self Employed
10.2014 - Current
Social Services Specialist
Baycare Health Systems
02.2013 - 12.2014
Case Management Assistance
Baycare Health Systems
11.2011 - 03.2014
Bachelor of Science Psychology and Cert in Behavioral Forensics -
University of Central Florida
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