Andrea Fila Email & Phone Number

Minnetonka, MN

• Created and grew positive partnerships with high-profile national medical provider groups to improve relationships, maintain network stability, drive growth and improve provider satisfaction
• Reduced call volumes to UHG customer service through provider education and related tools
• Increased claim resolution efficiency and decreased provider abrasion by coordinating escalated claim issues with multiple internal departments
• Took collaborative approach to working with providers in nationwide forums to ensure satisfaction of Medicare requirements and correspondingly improve product profitability
• Responsible for provider relationships worth $358 million in network spend.

• Recruited Chiropractors and Physical Therapists for national network to assure network adequacy and allow for profitable product implementation
• Optimized consistency and efficiency of contract implementation across internal segments to drive positive provider experience
• Directed customer complaints internally to maintain efficient issue resolution and support provider retention
• Managed relationship with leased networks to bolster network adequacy

• Managed daily network management activities for a team of 6 network representatives
• Oversaw complex issues involving strategic business partners to ensure quick resolution and provider retention
• Monitored, enhanced and documented provider recruitment strategy to quickly build geographically adequate network
• Ensured associates met provider recruitment deadlines for profitable product implementation
• Drafted critical network correspondence to reduce call volume to customer service

• Recruited Skilled Nursing Facilities to national network which resulted in 30% growth to the network satisfying Medicare requirements for network adequacy in Connecticut, Vermont, New Hampshire, New York, New Jersey.
• Negotiated facility reimbursement which produced a strong and profitable network
• Provided claims administration education to participating providers reducing call volume to customer service and improving Provider experience
• Coordinated provider relations and recruitment in the regional sites to eliminate cross over communication and improve provider onboarding process

• Acted as the primary liaison for contracted providers so that escalated issues were handled promptly
• Negotiated reimbursement with physician groups to provide competitive physician network
• Educated providers on PreferredOne payment methodologies allowing for efficient claims adjudication
• Facilitated internal meetings for efficient issue resolution
• Created and implemented online resources for provider network to reduce call volume to customer service
• Met with newly contracted providers to represent and educate the provider on company products and procedures

Advised clients about which products and services best meet their specific needs.Developed insurance quotes to garner sales.Collaborated with underwriting professionals to offer insurance coverage.Obtained Life, Accident and Health Insurance License.

Sold managed care services to employers, insurers and third party administrators. Sought new account prospects while maintaining and managing existing accounts.Prepared weekly reports regarding customer feedback and marketing opportunities.Developed proposals and presentations for new account prospects and existing clients.

Assisted with employment placement for disability claimants.Interviewed applicants and evaluated their job skills. Managed approximately 100 claims to determine status of disability and eligibility for benefits.

Ba, Art History

High School Diploma, College Prep