Frontline Leader Resume Samples
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Frontline Leader Resume Samples
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CB
C Batz
Caleigh
Batz
4991 Gleason Fields
Houston
TX
+1 (555) 105 7699
4991 Gleason Fields
Houston
TX
Phone
p
+1 (555) 105 7699
Experience
Experience
Dallas, TX
Frontline Leader
Dallas, TX
Emard, Ullrich and Beahan
Dallas, TX
Frontline Leader
- Executes for Results: Effectively leverages resources to create exceptional outcomes, embraces change, and constructively resolves barriers and constraints
- Successfully manage a team of 20-25 Customer Care Advocates
- You will have a team of 15-20 direct reports and you will report to a department manager
- Analyze data to guarantee key performance measures are met, while aiding in the removal of barriers to success
- Mentoring/coaching/developing of others
- Provide guidance and leadership to associates and serve as a mentor for their day-to-day activities
- Leads Positively: Leads by example to cultivate a climate of motivation, positive energy and meaning in work. Assesses, selects, recognizes, develops, and empowers diverse talent
Phoenix, AZ
HRA Frontline Leader
Phoenix, AZ
Zieme LLC
Phoenix, AZ
HRA Frontline Leader
- Manage daily workflow while ensuring quality, accuracy, and customer service
- Develop strategies for adapting to a constantly changing workload or unforeseen situations
- Maintain employee records and work schedules while ensuring adequate coverage at all times
- Hire, train, and evaluates the performance of associates
- Working knowledge of Medicare
- Ensure performance and compliance in a timely manner
- Actively participates in process improvement projects
present
Boston, MA
Workforce Management Frontline Leader
Boston, MA
Schaefer-Ullrich
present
Boston, MA
Workforce Management Frontline Leader
present
- Workforce Management Systems (Aspect, IEX, or related system)
- Process / Project Management
- Tool Development (using spreadsheets/databases/etc.to mimic functions of WFM software)
- Longevity working in an operational setting
- Effective Verbal and Written Communications
- Call Routing Systems / Concepts
- Proficiency in all Microsoft Office Programs, e.g. Word, PowerPoint, Excel, Access, etc
Education
Education
Bachelor’s Degree in Business Administration
Bachelor’s Degree in Business Administration
Columbia University
Bachelor’s Degree in Business Administration
Skills
Skills
- Able to give direction and make sound business decisions
- Excellent time management skills
- Excellent communication skills both written and verbal
- Proficiency in Microsoft Office Word, Excel and PowerPoint
- Experience in a team leadership or supervisory position
- Proven leadership and engagement experience
- Medical Technician or Certified Pharmacy Technician
- Previous supervisory experience in a call center setting
2 Frontline Leader resume templates
Read our complete resume writing guides
1
Frontline Leader Resume Examples & Samples
- Prior supervisory experience
- Ability to work independently under general instructions and with a team
- Valid drivers license and/or dependable transportation necessary
- Health Plan experience
- Prior Medicare / Medicaid experience
- May substitute equivalent education and/or experience for degree
- Bilingual is a plus
2
Frontline Leader Resume Examples & Samples
- Current RN license in the state in which the nurse is / will be required to practice
- Ability to be licensed in multiple states without restrictions
- Progressive clinical experience preferably in an acute care, skilled or rehabilitation clinical setting
- Associates working in the state of Arizona must comply with the Tobacco Free Hiring Policy (see details below under Additional Information) and upon offer will be subjected to nicotine testing as part of a 10 panel drug test
- BSN or Bachelors degree in a related field
- Call center or triage experience
- Previous experience in utilization management, discharge planning and/or home health or rehab
3
PPI Frontline Leader Resume Examples & Samples
- High School Diploma
- Previous supervisory experience
- Applied knowledge of insurance processing
- Proficiency in all Microsoft Office Programs, e.g. Word, PowerPoint, Excel, Access, etc
- Associate’s or Bachelor’s Degree
- Power MHS Knowledge
- Previous medical claims processing experience in Medicaid
- Prior work experience in a fast paced, metric driven operational setting
- General understanding of economic, financial and operational concepts
4
Frontline Leader Utilization Management Resume Examples & Samples
- Ability to be licensed in multiple states without restrictions
- Strong clinical experience in an acute care, skilled or rehabilitation clinical setting
- Experience in utilization or case management working with Medicare criteria
5
Frontline Leader San Juan Resume Examples & Samples
- Bachelor degree or Master degree in Nursing (preferable) or related field
- Active nursing licensed for Puerto Rico
- Actively subscribe to the CPEPR
- Valid driver’s license and/or dependable transportation necessary
- Progressive clinical experience preferably in an acute care, skilled or rehabilitation clinical setting
- Prior supervisory experience
- Computer leverage
- Ability to work independently under general instructions and with a team
- Ability to work with strict timeframes and under pressure
- Health Plan experience
- Prior Medicare / Medicaid experience
- Previous experience in utilization management, discharge planning and/or home health or rehab
- Bilingual is a plus
6
Grievance & Appeals Frontline Leader Resume Examples & Samples
- Assist with staffing levels that are achieved to ensure resources are managed effectively
- Identify shifting workload patterns as effected by regulatory changes
- Provide guidance and leadership to associates and serve as a mentor for their day-to-day activities
- Identify reasons for variation in individual performance and assist in outlining appropriate actions that will result in improved performance
- Analyze data to guarantee key performance measures are met, while aiding in the removal of barriers to success
- Maintain proactive and routine communication with other departments to ensure efficient, accurate and timely responses to internal/external customer needs
- High School Diploma or equivalent
- Minimum of 2 years supervisory experience over 7 or more direct reports
- Associate’s or Bachelor’s Degree
- Previous experience in healthcare
- Knowledge of insurance processing, customer service or call center processes and practices
- General understanding of healthcare economic, financial and operational concepts
- Results oriented; problem solver
- Excellent written, verbal and electronic communication skills
- Strong presentation skills; ability to address small and large groups of diverse backgrounds
7
Frontline Leader Resume Examples & Samples
- Ensure appropriate staffing levels are achieved to ensure resources are managed effectively
- Provide guidance and leadership to associates and serve as a mentor for their day-to-day activities
- Identify reasons for variation in individual performance and take appropriate actions that will result in improved performance
- Analyze data to guarantee key performance measures are met, while aiding in the removal of barriers to success
- Ability to multi-task in several environments if needed.(Dispensing, OTC, Shipping/Packout, Inventory)
- Maintain proactive communication with other departments to ensure efficient, accurate and timely responses to internal/external customer needs
- Monitors quality and production and holds associates accountable for meeting and exceeding expectations
- Drive engagement and associate development
- High School Diploma or Equivalent
- PTCB Certified and Arizona Pharmacy License
- 1 year or more of Pharmacy experience
- Ability to lift a minimum of 25 lbs
- Ability to stand entire shift
- Experience in a team leadership or supervisory position
- Excellent time management skills
- Excellent communication skills both written and verbal
- Proficiency in Microsoft Office Word, Excel and Outlook
- Able to give direction and make sound business decisions
- Associates or Bachelor’s Degree
- Previous supervisory experience in a mail order setting
8
Frontline Leader Resume Examples & Samples
- Actively manage the Call Center floor to ensure Service Level agreements are attained
- Participate on project teams to drive an exceptional experience for both internal and external customers
- 1 year or more of Leadership experience
- Successfully manage a team of 20-25 Customer Care Advocates
- Demonstrate the ability to drive an excellent customer experience
- Proficiency in all Microsoft Office Programs, e.g. Word, PowerPoint, and Excel
- Drive associate and customer well-being
- Abilty to multi-task and drive productivity
- Schedule availability – must be available to work Two (2) Saturdays a month 8:00am-6:30pm, a week day schedule with hours between 8 a.m. – 8:00p.m., including Holidays, and a 12 hour schedule daily during peak season (January-March)
- Associate’s or Bachelor’s Degree
- Insurance Processing
- Pharmacy or Mail Order Pharmacy Experience
- Longevity working in an operational setting
- General understanding of economic, financial and operational concepts
9
PPI Frontline Leader Resume Examples & Samples
- Bilingual candidates (English and Spanish)
- Associate Degree or equivalent experience
- Previous supervisory or leadership experience
- Applied knowledge of insurance processing, claims, customer service and/or processes and practices
- Ability to operate in collaborative environment
- Experience with managing quality metrics and monitor feedback
- Proficiency in all Microsoft Office Programs, e.g. Word, PowerPoint, Excel, etc
- Bachelor’s Degree
10
Frontline Leader Resume Examples & Samples
- High School Diploma or equivalent
- Experience in Call Center Leadership
- Previous supervisory experience
- Ability to operate in collaborative environment
- Experience with managing quality metrics and monitor feedback
- Applied knowledge of insurance processing, customer service or call center processes and practices
- Proficiency in all Microsoft Office Programs, e.g. Word, PowerPoint, and Excel,
- Flexibilty to work 5:00am-8:00pm Monday- Friday and Saturday 5:00am-3:30pm. Holidays as needed, hours subject to change based on business needs
- Healthcare experience
11
Frontline Leader Resume Examples & Samples
- Drive a team to achieve results
- Efficient time management skills
- Proficiency in Microsoft Office Word, Excel and PowerPoint
- Certified Pharmacy Technician (PTCB)
- Bachelor’s Degree
- Mail order pharmacy experience
- Call center experience in a leadership capacity
12
Acute Utilization Management Frontline Leader Resume Examples & Samples
- Current RN license in the state of North Carolina without restrictions
- Previous experience in utilization management
- Valid driver’s license and/or dependable transportation necessary
13
Frontline Leader Resume Examples & Samples
- High School Diploma
- Ability to learn insurance processing, customer service or call center processes and practices
- Proficiency in all Microsoft Office Programs, e.g. Word, PowerPoint, Excel, etc
- Previous call center and/or call center background
- Prior work experience in an operational setting
14
Medicaid Frontline Leader Region Resume Examples & Samples
- Master's Degree with at least 2 years of case management experience with at least 1 year focused on elderly or disabled populations
- Bachelor's Degree in a health related field with at least 5 years of case management experience with at least 1 year focused on the elderly or disabled populations
- 9 years of RN experience with a minimum of 5 years of case management experience with at least 1 year focused on the elderly or disabled population
- Active RN license in the state of FL
- Prior supervisory experience
- Possession of valid driver's license with access to an automobile
- Must have a separate room with a locked door that can be used as a home office to ensure you and your patients have absolute and continuous privacy while you work
- Must have accessibility to high speed DSL or Cable modem for a home office (No Satellite)
- Intermediate to advanced computer skills and experience with Microsoft Word, Excel and Outlook
- This role is considered patient facing and is a part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB
- AHCA Fingerprint Required
- Health Plan experience
- Prior Medicare / Medicaid experience
- Prior nursing home diversion or long term care case management experience
- Call center or triage experience
- May substitute equivalent education and/or experience for degree
- Previous experience in utilization management, discharge planning and/or home health or rehab
- Bilingual is a plus
15
Ltss Transitions Frontline Leader Region Resume Examples & Samples
- Master's Degree with at least 2 years of case management experience with at least 1 year focused on elderly or disabled populations
- Bachelor's Degree in a health related field with at least 5 years of case management experience with at least 1 year focused on the elderly or disabled populations
- Possession of valid driver's license with access to an automobile
- Must have a separate room with a locked door that can be used as a home office to ensure you and your patients have absolute and continuous privacy while you work
- Must have accessibility to high speed DSL or Cable modem for a home office (No Satellite)
- Intermediate to advanced computer skills and experience with Microsoft Word, Excel and Outlook
- This role is considered patient facing and is a part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB
- AHCA Fingerprint Required
- Prior supervisory experience
- Health Plan experience
- Prior Medicare / Medicaid experience
- Prior nursing home diversion or long term care case management experience
- Call center or triage experience
- May substitute equivalent education and/or experience for degree
- Previous experience in utilization management, discharge planning and/or home health or rehab
- Bilingual is a plus
16
Frontline Leader Resume Examples & Samples
- RN license, active and unrestricted
- BSN or higher degree in nursing, business or healthcare field preferred
- At least 3-5 years of clinical experience; preferably in an acute care, skilled, or rehabilitation clinical setting
- Excellent communication skills
- Ability to work independently, and within a team
- Minimal travel required
- Previous health plan operations experience
- Experience with management of nursing personnel in person or in the virtual space
- Knowledge of Humana systems and clinical programs
- Professional business writing skills and presentation skill
17
Medicaid Frontline Leader Resume Examples & Samples
- Master's Degree with at least 2 years of case management experience with at least 1 year focused on elderly or disabled populations
- Bachelor's Degree in a health related field with at least 5 years of case management experience with at least 1 year focused on the elderly or disabled populations
- 9 years of RN experience with a minimum of 5 years of case management experience with at least 1 year focused on the elderly or disabled population
- Active RN license in the state of FL
- Prior supervisory experience
- This role is part of Humana’s Driver safety program and therefore requires an individual to have a valid state driver’s license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits
- Must have a separate room with a locked door that can be used as a home office to ensure you and your patients have absolute and continuous privacy while you work
- Must have accessibility to high speed DSL or Cable modem for a home office (No Satellite)
- Intermediate to advanced computer skills and experience with Microsoft Word, Excel and Outlook
- This role is considered patient facing and is a part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB
- AHCA Fingerprint Required
- Health Plan experience
- Prior Medicare / Medicaid experience
- Prior nursing home diversion or long term care case management experience
- Call center or triage experience
- May substitute equivalent education and/or experience for degree
- Previous experience in utilization management, discharge planning and/or home health or rehab
- Bilingual is a plus
18
Frontline Leader Resume Examples & Samples
- Current RN license in the state in which the nurse is / will be required to practice Ability to be licensed in multiple states without restrictions
- Good interpersonal and communication skills
- Ability to gather, analyze, interpret, and offer insights into target HEDIS indicators
- Prior work-at-home experience
- Knowledge of HEDIS and CMS Stars measurements
19
Frontline Leader Resume Examples & Samples
- Brings strong attention to detail and time management skills
- Possesses excellent communication and problem solving skills
- Proficiency in all Microsoft Office Programs, e.g. Word, PowerPoint, Excel, Access, etc
- Ability to work more than 40 hrs/wk during peak season
- Prior work experience in an operational setting and/or inventory management
- Previous compliance experience
20
Workforce Management Frontline Leader Resume Examples & Samples
- Ensure appropriate staffing levels are achieved to ensure resources are managed effectively
- Provide guidance and leadership to analysts and serve as a mentor for their day-to-day activities
- Identify reasons for variation in individual performance and take appropriate actions that will result in improved performance
- Ensure the professional development of each of the workforce specialists
- Willing to be “in the game” with the specialists to inspect what you expect while also leading by example
- Build relationships with the operational leaders specifically the manager, supervisor and team leads
- Drive real time strategies including skilling, shrinkage utilization, as well as partner with operations to drive representative behaviors especially around call handling
- Coordinate with local leadership teams to schedule offline activities to balance SVL’s while also ensuring that local and national priorities are met
- Applied knowledge of insurance processing, customer service or call center processes and practices
- Proficiency in all Microsoft Office Programs, e.g. Word, PowerPoint, Excel, Access, etc
- Effective Verbal and Written Communications
- Understanding of Workforce Management Concepts
- Longevity working in an operational setting
- Workforce Management Systems (Aspect, IEX, or related system)
- Call Routing Systems / Concepts
- Tool Development (using spreadsheets/databases/etc.to mimic functions of WFM software)
- Process / Project Management
- Root Cause & Data Analysis
- Outbound Call Dialer Comprehension
- Previous Avaya CMS utilization
21
.mra Frontline Leader Resume Examples & Samples
- Prior supervisory experience
- Ability to work independently under general instructions and with a team
- Valid drivers license and/or dependable transportation necessary
- Computer experience with MS Office (PowerPoint, Word, Excel) including reporting
- Independent experience loading information on a flash drive, scanners and laptop
- Must be able to travel 25% to South Carolina and Georgia with occasional over-night stays
- Bachelor’s degree in a related field
- Previous leadership experience in a healthcare environment
- Health Plan experience
- Prior Medicare / Medicaid experience
- Call center or triage experience
- May substitute equivalent education and/or experience for degree
- Bilingual is a plus
22
PNO Frontline Leader Resume Examples & Samples
- Ensure appropriate staffing levels are achieved to ensure resources are managed effectively
- Provide guidance and leadership to associates and serve as a mentor for their day-to-day activities
- Identify reasons for variation in individual performance and take appropriate actions that will result in improved performance
- Analyze data to guarantee key performance measures are met, while aiding in the removal of barriers to success
- Maintain proactive communication with other departments to ensure efficient, accurate and timely responses to internal/external customer needs
- Associates Degree in Business Administration, Management, Accounting, Finance or related field
- Prior supervisory experience
- Knowledge on Medical terminology (CPT-4, ICD-9, ICD-10); background in claims processing and/or utilization and/or provider negotiation is required
- Very strong analytical and problem-solving skills
- Excellent written and oral communication skills in both, English and Spanish with the ability to communicate inside and outside of Humana
- Comprehensive knowledge on computer systems (MS Word, Excel, Power Point, and the Internet)
- Ability to meet deadlines, work with tight schedules and manage multiple priorities under minimum supervision
- Ability to work independently with general instructions with the team
- Computer Leverage
- Fully bilingual
- Health Plan experience
- Prior Medicare / Medicaid and Commercial Experience
23
Telesales Frontline Leader Miramar, Florida Resume Examples & Samples
- High School Diploma
- Prior work experience in an operational setting, with demonstrated supervisory experience
- Applied knowledge of insurance processing, customer service or call center processes and practices
- Direct Sales experience and sales management experience including sales agent development
- Associate’s or Bachelor’s Degree of Art or Science
- General understanding of economic, financial and operational concepts
- Mentoring/coaching/developing of others
- Healthcare experience
- Bilingual English/Spanish or English/Creole
24
Telesales Frontline Leader Resume Examples & Samples
- High School Diploma
- Prior work experience in an operational setting, with demonstrated supervisory experience
- Applied knowledge of customer service or call center processes and practices
- Associates working in the state of Arizona must comply with the Tobacco Free Hiring Policy (see details below under Additional Information) and upon offer will be subjected to nicotine testing as part of a 10-panel drug test
- Associate’s or Bachelor’s Degree of Art or Science
- Applied knowledge of insurance processing
- General understanding of economic, financial and operational concepts
25
PNO Frontline Leader Resume Examples & Samples
- Associates Degree in Business Administration, Management, Accounting, Finance or Health related field
- Knowledge on Medical terminology (CPT-4, ICD-9, ICD-10); background in credentialing
- Very strong analytical, problem-solving and operational strategic skills
- Ability to work under pressure
26
Frontline Leader Resume Examples & Samples
- Master's Degree in human services, social sciences, or health related field with at least 2 years of case management experience with at least 1 year focused on elderly or disabled population
- Bachelor's Degree in a health related field with at least 5 years of case management experience with at least 1 year focused on the elderly or disabled population
- 9 years of professional human service experience with a minimum of 5 years of case management experience with at least 1 year focused on the elderly or disabled population
- Active RN or LPN license in the state of FL
- This role is part of Humana’s Driver safety program and therefore requires an individual to have a valid state driver’s license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits
- Must have a separate room with a locked door that can be used as a home office to ensure you and your patients have absolute and continuous privacy while you work
- Must have accessibility to high speed DSL or Cable modem for a home office (No Satellite)
- Intermediate to advanced computer skills and experience with Microsoft Word, Excel and Outlook
- This role is considered patient facing and is a part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB
- AHCA Fingerprint Required
- Previous leadership experience
- BSN or Bachelor’s degree in a related field
- Previous Medicare/Medicaid Experience a plus
- Prior nursing home diversion or long term care case management experience
- Experience with health promotion, coaching and wellness
- Experience working with the geriatric population
27
DMS Telesales Frontline Leader Resume Examples & Samples
- High School Diploma
- Prior work experience in an operational setting, with demonstrated supervisory experience
- Applied knowledge of insurance processing, customer service or call center processes and practices
- Associate’s or Bachelor’s Degree of Art or Science
- General understanding of economic, financial and operational concepts
28
DMS Frontline Leader Resume Examples & Samples
- High School Diploma
- Prior work experience in an operational setting, with demonstrated supervisory experience
- Applied knowledge of insurance processing, customer service or call center processes and practices
- Associate’s or Bachelor’s Degree of Art or Science
- General understanding of economic, financial and operational concepts
29
Frontline Leader Utilization Management Resume Examples & Samples
- Current RN license in the state of TX
- Experience in utilization review
- Proven ability ina leadership, preceptor or mentor type role
- Clinical experience an adult acute care, skilled or rehabilitation clinical setting
- Must have accessibility to high speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed for this role); and recommended speed for optimal performance from Humana At Home's systems if 5Mx1M
30
Frontline Leader Resume Examples & Samples
- Previous experience in a team leadership or supervisory position
- Licensed Pharmacy Technician in Arizona
- PTCB Certified
- Minimum of High School Diploma or GED
- Must be self-motivated
- Proficiency in Microsoft Office Word, Excel and Powerpoint
31
Frontline Leader Resume Examples & Samples
- Prior work experience in an operational setting, with demonstrated supervisory experience
- State Health License
- Associate’s or Bachelor’s Degree of Art or Science
- Previous Call Center experience
32
DMS / Telesales Frontline Leader Resume Examples & Samples
- High School Diploma
- Prior work experience in an operational setting, with demonstrated supervisory experience
- Applied knowledge of insurance processing, customer service or call center processes and practices
- Associates working in the state of Arizona must comply with the Tobacco Free Hiring Policy (see details below under Additional Information) and upon offer will be subjected to nicotine testing as part of a 10-panel drug test
- Associate’s or Bachelor’s Degree of Art or Science
- General understanding of economic, financial and operational concepts
33
Frontline Leader Resume Examples & Samples
- Previous supervisory/leadership experience
- Strong working knowledge of insurance processes and practices
- Strong communication skills, both written and verbal
- Proficiency in all Microsoft Office Programs, e.g. Word, PowerPoint, Excel
- Quality and/or Medicare processes
34
Frontline Leader Resume Examples & Samples
- Proven leadership and engagement experience
- Medical Technician or Certified Pharmacy Technician
- Previous supervisory experience in a call center setting
35
Frontline Leader, Case Management Resume Examples & Samples
- Progressive clinical experience in an acute care, skilled or rehabilitation clinical setting
- Previous experience in case management and related activities
- Prior Medicare / Medicaid experience
36
HRA Frontline Leader Resume Examples & Samples
- Provide assistance in training to include communication of guidelines/policies and procedures, ride along visits with Care Coordinators (CC)/Transition Coordinators(TC); promote teamwork and a positive working environment for the care coordinators
- Forecasts and manages resources to meet the needs of the business
- Visit Compliance monitoring: Assist RM as directed to review CC Dashboard for compliance for TAT’s and visits for HCBS and NF members for new enrollees and ongoing members and develop innovative approaches to help manage caseloads
- Serve as an expert, leader and mentor for other team members
- Identify members with the potential for high-risk complications and coordinate the appropriate supported self-care in conjunction with the member and care coordination team
- Act as an advocate for an individual’s care needs by identifying and communicating opportunities for care interventions, including identifying and addressing functional deficits and gaps in care; Anticipates customer needs and proactively develops solutions to meet them
- Develop member specific POC that will be utilized to obtain authorizations for appropriate home and community based services, collaborating with CMA staff to obtain authorization for those services and confirms that services are being provided and the member’s needs are being met
- Monitor and ensure that the provision of covered physical health, behavioral health, and/or home and community based services are provided as a cost-effective alternative
- Management of critical transitions, supporting legacy discharge planning staff with member transition to the home setting
- Assist in member care transitions, monitoring initiation and daily provision of services in accordance with the member’s POC; taking immediate action to resolve gaps in care
- Develop and implement targeted strategies to improve health, functional or quality of life outcomes, such as disease management or pharmacy management
- Serve as a point of contact for coordination of all physical health, behavioral health and other home and community based services
- Proactively educate members about the program, including opportunities for consumer direction of HCBS and obtain necessary consents for participation
- Coordinate with the Fiscal Employer Agent (FEA) for consumer direction members, as needed
- Conduct, review and revise, as necessary, member’s risk assessment and risk agreement
- Maintain appropriate and ongoing communication and collaboration with members, their authorized representations, physicians and health team members and payer representatives
- Monitor hospitalizations and institutional facility admissions and readmissions to identify issues and implement strategies to improve outcomes
- Provide assistance in resolving concerns about service delivery or providers
- Development of a member specific POC by coordinating with member’s primary care provider, specialists and other providers and care programs to ensure comprehensive, holistic, person centered approach to care
- Provide members with education about the ability to use advance directives
- Routinely assess and monitor member’s status, needs and progress; if progress is static or regressive, determine reason and proactively encourage appropriate adjustments to their plan of care, providers and/or services to promote better outcomes
- Report quantifiable impact, quality of care and/or quality of life improvements as measured against the care coordination goals
- Establish and maintain professional working relations with referral sources, community resources and care providers
- Collaborates with their peers on member admissions, transitioning and/or discharge planning
- Bachelor’s degree in Business Administration or related field
- Prior experience prior supervisory experience (at least 2 years)
- Demonstrated ability to communicate with members with complex medical needs that may have communication barriers
- Experience navigating resources and computer systems to access information
- Results driven; ability to lead with influence and persuasion as a fully integrated team member
- Possess a strong attention to detail, sound critical thinking and follow up skills
- Ability to manage multiple priorities simultaneously; and work within contractual timelines and short turn-around times
- Demonstrated ability to work effectively in vertically-matrix organizations
- Excellent communication skills, both written and verbal
- Ability to evaluate data, use appropriate problem solving, research and analysis tools
- Fully Bilingual English/Spanish
- Intermediate to advanced user of Excel, Word, Access and hardware expertise
- Knowledge of insurance processing or call center processes/practices
- Function independently and responsibly with minimal need for supervision
- Develop strategies for adapting to a constantly changing workload or unforeseen situations
- Ability to anticipate reporting needs and identify areas for improvement
- Experience in the health care industry
37
Grievance & Appeals Frontline Leader Resume Examples & Samples
- Minimum of an Associate’s Degree
- Must have a Nursing Degree
- Bilingual English/Spanish - must be able to speak, read and write in both languages without limitations or assistance
- Minimum of 2 years prior supervisory experience over 7 or more direct reports
- Experience working in a high volume production environment
- Previous experience in working in the healthcare industry
- Must have prior Medicare experience and knowledge of the CMS guidelines
- Intermediate in Microsoft Office Programs Word, Excel
- Beginner knowledge PowerPoint and Access
- Experience working in a G&A environment
38
Frontline Leader Resume Examples & Samples
- Applied knowledge of customer service or call center processes and practices
- Direct Sales experience and sales management experience including sales agent development
- Applied knowledge of insurance
- Mentoring/coaching/developing of others
- Bilingual English/Spanish or English/Creole
39
Member Services Frontline Leader Resume Examples & Samples
- Ensure appropriate staffing levels are achieved to ensure resources are managed effectively
- Provide guidance and leadership to associates and serve as a mentor for their day-to-day activities
- Identify reasons for variation in individual performance and take appropriate actions that will result in improved performance
- Analyze data to guarantee key performance measures are met, while aiding in the removal of barriers to success
- Maintain proactive communication with other departments to ensure efficient, accurate and timely responses to internal/external customer needs
- Monitor and ensure that all escalated calls are appropriately responded to by the Production Lead by EOB
- High School Diploma or equivalent
- Previous supervisory experience over direct reports
- Must have experience in call center processes and practices
- Intermediate knowledge of Microsoft Office Programs Word, PowerPoint, Excel
- Ability to work extended hours based on business needs
- Bilingual English/Spanish - must be able to speak, read and write in both languages without limitations or assistance
- Strong ability to multi task and organizational skills
- Strong communication skills
- Ability to travel up to 50% to Tampa initially and over time will be less
- Associate’s or Bachelor’s Degree
- Medicare knowledge
- Healthcare industry knowledge
- Prior work experience in an operational setting
- General understanding of economic, financial and operational concepts
40
Frontline Leader / Medicare Claims Resume Examples & Samples
- Ensure appropriate staffing levels are achieved to ensure resources are managed effectively
- Identify reasons for variation in individual performance and take appropriate actions that will result in improved performance
- Analyze data to guarantee key performance measures are met, while aiding in the removal of barriers to success
- Maintain proactive communication with other departments to ensure efficient, accurate and timely responses to internal/external customer needs
- Bachelor’s degree in Business Administration or related field or a minimum of 3 years experience in a similar role
- Minimum three years experience as claims analyst
- Excellent organizational and administrative skills
- Knowledge of MS Office (Word, Excel, Power Point)
- Strong leadership and supervision skills
- Ability to work in a professional and structured environment
- Bilingual English and Spanish. (Candidate selected will not be communicating with Members in English)
- Team player, ability to work with tight schedules and multiple priorities
- Bachelors degree in Business Administration
- Knowledge of insurance processing or call center processes/practices
- Experience in the health care industry
- Prior experience prior supervisory experience (at least 2 years)
- Experience in Medicare
- General understanding of economic, financial and operational concepts
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Frontline Leader, Utilization Management Resume Examples & Samples
- Prior supervisory or managed care experience
- This role requires a TB screen
- Health population experience
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Utilization Management Frontline Leader Resume Examples & Samples
- Report trends
- Develop system-view recommendations
- Implement appropriate actions to control trend
- Create and conducts provider outreach initiatives
- Ensure compliance with regulatory requirements
- Recommend alternatives if appropriate using your knowledge of clinical protocols
- Identify members for specific case management and / or disease management activities
- Monitor case management activities, post-discharge calls, discharge planning and pre-assessment of elective admissions
- At least five years of progressive clinical experience preferably in an acute care, skilled or rehabilitation clinical setting
- At least two years prior supervisory experience
- BSN or Bachelors degree in a related field
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HRA Frontline Leader Resume Examples & Samples
- Supervise the department’s day-to-day operations
- Hire, train, and evaluates the performance of associates
- Ensure performance and compliance in a timely manner
- Maintain employee records and work schedules while ensuring adequate coverage at all times
- Manage daily workflow while ensuring quality, accuracy, and customer service
- Recommend procedural and system changes to improve operational quality and efficiency
- Actively participates in process improvement projects
- Associate’s degree, 2 years of college or equivalent experience
- Informal Leadership experience
- This position is full-time (40 hours/week) Monday – Friday from 8am-6pm. It may be necessary, given the business need to work additional hours
- Working knowledge of Word and Excel, able to do basic formulas and create spreadsheets
- Bilingual English/Spanish - must be able to speak, read and write in both languages without limitations or assistance
- This role will conform to US holidays as opposed to Puerto Rico holidays
- Health Plan experience
- Working knowledge of Medicare
