Joshua R. Email & Phone Number

Jacksonville, Fl, Us

United States

I contributed extensively to UHC's Claims Research Team, specializing in large-scale Medicaid claim projects across several key states including Florida, New York, New Jersey, Tennessee, and Virginia. My role involved meticulous coordination with state Medicare plans to ensure adherence to regulatory procedures. I focused on processing and reviewing hospital and professional medical claims, handling adjustments and ensuring compliance with insurance guidelines.Additionally, I provided support for overflow activities related to Medicaid plans in Texas, Minnesota, DC, and Louisiana as needed. I was also cross-trained in the Accounts Receivable Operations (ARO) department, where I managed claim recoupment requests directly from providers and vendors. This included either fulfilling the requested recoupment or providing detailed explanations for invalid requests along with guidelines for correction.A crucial aspect of my role was identifying and reporting any indications of medical fraud discovered during the processing of large-scale projects.

Orlando, Florida, United States

I played a key role in the development of Mayor Buddy Dyer's Visitor Toll Pass Program, supporting our project manager and overseeing a team of Customer Service representatives at Orlando International Airport. My responsibilities included generating daily reports for senior management, encompassing customer feedback, operational issues, error reports using Microsoft PowerBI metrics, and addressing employee needs promptly.During my tenure, I made significant contributions to process improvement initiatives, focusing on enhancing customer conflict resolution, optimizing payment procedures, and maximizing product positioning to enhance customer engagement. I conducted monthly inventory audits to ensure accurate reporting of product inventory losses and maintained close collaboration with our IT department to promptly address any technical issues affecting operations.I was entrusted with the responsibility of contacting international customers for unpaid dues, a role I assumed based on positive feedback received from customer interactions. As a manager of the airport customer service team, I provided daily support, conducted training sessions, and held regular meetings to establish clear daily expectations.I left the project due to the end of the contract nearing and returned to United Health Care

Jacksonville, Florida

I played a pivotal role in launching Optum RX's inaugural consumer onboarding department, a collaborative project spanning two sites aimed at educating and onboarding commercial clients' employees on Part D health insurance benefits. My responsibilities included explaining medication coverages, facilitating prior authorization and step therapy requirements with doctors' offices, and setting up personal mail-order pharmacy accounts as needed. I initiated outbound calls and organized follow-up meetings to ensure comprehensive client support, providing my direct contact information for ongoing assistance.As part of this initiative, I led the creation of in-call scripting and post-call documentation, leveraging my communication expertise. I also resolved a SharePoint challenge by implementing a multi-site Microsoft OneNote solution, assuming responsibility for its training and upkeep to ensure project SOPs and essential documents remained current.Additionally, I supported overflow calls for traditional mail-order customer service, assisting customers with medication orders, explaining insurance benefits, and ensuring compliance with federal medicine regulations. From November 2017 to January 2020, I consistently achieved goals for Average Handle Time, First Call Resolution, and Medication Conversion through proactive inbound and outbound call management.Following a layoff during the COVID-19 pandemic, I rejoined the company in 2023 to contribute to the Claims Research Team.

Jacksonville, Florida

In this role, I specialized in assisting customers with transaction and identity fraud. This involved analyzing purchase patterns, conducting thorough verification processes, and validating customer information through LexusNexus. I was trained to recognize and report suspicious trends promptly. Notably, I identified a significant $200,000 fraud trend in South Florida, underscoring my attention to detail and proactive approach to fraud prevention.A key aspect of my role was educating customers on identity fraud solutions and guiding them through the necessary processes to mitigate risks effectively.Additionally, I was selected to participate in the launch of the Costco CitiCard collaboration, facilitating the smooth onboarding of customers to their new Citibank accounts post-transition.Left due to health issues that required immediate attention.