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The sample below is for a Health Insurance Management CV Resume Sample. This resume CV was written by a ResumeMyCareer professional CV resume writer, and demonstrates how a CV resume for an Executive Management CV Resume Sample should properly be created. Our Certified Professional CV Resume Writers can assist you in creating a professional document for the job or industry of your choice.

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Health Insurance Management

Dynamic, experienced, articulate, and savvy Health Insurance Manager, with more than 19-years experience in TPA and Healthcare insurance and business initiatives. Capacity to reduce unnecessary health care costs through a variety of methods, including: economic incentives for physicians and patients to select lower costs forms of care; programs for reviewing specific medical services; increasing beneficiary costs, and placing controls on impatient admissions and lengths of stay, to name a few. Provide strategic claims system and adjudication skills, management and leadership, and detail-oriented account management expertise. Proficient in MS Word, Excel, Lotus, Access, T-C Plus, Easwin, HYPERprep,

CORE STRENGTHS

 Business Analytics
 Quality Assurance
 Change Management
 Claims Systems/Adjudication
 Communications
 Healthcare/TPA
 Customer Service
 Cost/Benefit Analyses
 File Underwriting

PROFESSIONAL EXPERIENCE
Hallmark Service Corporation, Naperville, IL 2005 –2011
Claims Investigator/Examiner (Membership Review/Risk Management Unit)
 Performed detailed reviews and investigations for claims filed on individual health insurance policies for the states of TX, IL, NM and OK.
 Oversaw all medical record reviews, contacted providers on any noted issues or concerns and successfully prepared all Underwriter filings.

Regional Sales Director – Innovative Cost Solutions, Inc., Chicago, IL 2004 –2005
 Successfully marketed company services to TPA’s, Reinsurance, Worker’s Compensation Companies, Fully Insured Insurance Companies, and Self-Funded Groups.
 Performed all strategic negotiations on health claims cost, and oversaw all Account Management policies.
 Provided leadership to 5 employees on customer follow-up and action plans.

Membership Team Lead – UniCare/WellPoint, Plan, TX/Chicago, IL 2001 to 2004
 Provided key Account Management functions for membership and billing processes for clients.
 Oversaw efficient and effective processing of more than 30 employers, and processed monthly revenue and production reports.
 Assisted Sales, Account Mangers and business associates on any issues that needed clarification.
 Collaborated with IT Department on system conversions and issues.
 Key reconciliation of invoices, audits, AR processing, payment history analyses, and collections.
 Provided key training and development initiatives for all new hires and existing employees.

Early Career:
Manager/Compliance Analyst – Group Resources, Inc. / Tucker & Clark, Inc., Dallas, TX 1997 to 2001
Customer Service Representative/Supervisor – Pioneer Financial Services, Irving, TX 1995 to 1997
Labor Market Analyst – Bureau of Labor & Statistics/Texas Employment Commission, TX 1994 to 1995
Unemployment Insurance Claim Analyst – Unemployment Insurance Claim Analyst, TX 1992 to 1994

EDUCATION / CERTIFICATIONS / PROFESSIONAL TRAINING
B.B.A., Finance & Real Estate – Angelo State University, San Angelo, TX
American Health Insurance Plans Certifications: Health Insurance Associate │Managed Healthcare Professional
DeVry, Irving, TX – C+ programming, Computer Building – 3.5 GPA
Waubonsee Community College – SQL Syntax

Affiliations:
North Texas Investment Group Treasurer │Gryphon Players Theatre Group Board Member
ASU Student Senate Senator │ ASU’s Finance/Real Estate Organization President

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