Craig Valchine Email & Phone Number

Us

Serve as a Claims Quality Analyst for UnitedHealthcare's Government Appeal Operation's Independent Review Entity (IRE) Validation Team. Previously served as a Senior Appeals and Grievance Coordinator on the uphold audit team.Analyze and validate the research of cases forwarded from uphold audit team.Review and analyze upheld claims to ensure the claims are processed in accordance with the member's contractual agreement and Medicare regulations.Audit, prepare, and finalize, on average, nine uphold case files a day for review by the Independent Review Entity assigned by Medicare (Maximus Federal Services).Research and respond to additional information requests made by Maximus Federal Services during their review.Communicate potential issues identified during the audit process to applicable teams to minimize risk to the company's Medicare Star-Ratings that directly impact annual bonuses received from Medicare.Analyze, identify, and communicate relevant appeal patterns, trends, and irregularities to leadership.Trained and mentored five new hires to the IRE Validation Team on the audit and preparation of Maximus case files. Previously trained two new hires as Senior Appeals and Grievance Coordinator on the uphold audit teamLed project from October 2020 through April 2021, responsible for coaching and mentoring seven offshore coordinators in the audit process to assist with the inventory demands of the IRE Validation Team.Review, execute, and provide constructive feedback regarding new team strategies and new systems implementation set forth by the leadership team.Assigned as the team's Macro specialist to troubleshoot issues with the company's system macros that assist with preparing and reviewing uphold case files.

Jacksonville, Fl, Us

I served as the Customer Service Manager and have served as the Center Store Area Manager. • Oversaw daily store operations of front-end and pricing departments to ensure an exceptional shopping experience for customers.• Responsible for recruiting, training, and developing team members to ensure store productivity, product merchandising, and team effectiveness to maximize the store's gross revenues and EBITDA. • Managed inventory, ordering processes, and in-stock position to merchandise for daily operations and seasonal and non-seasonal advertisements effectively. • Collaborated with outside vendors to improve the customer shopping experience through product selection, placement, and quality control.• Evaluated department conditions and operations to determine strengths and areas of missed opportunities while developing and empowering team members to improve on opportunities.• Ensured departments were consistent with all aspects of federal, state, and company health, safety, and sanitation codes.• Managed operations and security of company assets, including all cash office procedures.

Little Rock, Ar, Us

Served as the sales manager for the men's, shoes, home, and women's special sizes departments. • Managed and revitalized numerous departments with a proven track record for increasing sales and improving profitability. • Between 2010 and 2012, saw an average increase of 7% year over year. Essential for the store's sales increase of 1.6 million (6.9%) in 2012. Left with an 8.4% increase in sales and a 21.3% increase in gross margin volume (40.11% gross margin YTD) in 2013.• Communicated with senior store management and corporate executives on various business initiatives, including training philosophy, sales techniques, staffing/recruiting, merchandising, and reducing shrinkage.• Selected to the management team responsible for the new store's grand opening in Ocala, FL. Involved in training the store's staff on company policy, effective merchandising, client development, and the company's technology systems. • Proficient in the company's technology systems and policies. Responsible for training new managers on technology systems and was selected to a panel to determine how to improve and update the training process for newly hired managers.

Served as assistant to the theatre management team. • Responsible for floor operations management, functioned as customer liaison, and ensured a positive customer experience.• Responsible for associate training, coaching, and continued development in all areas of theatre operations.• Developed proficiency in customer service and problem-solving skills through routine interaction with customer complaint resolution, and attention to special needs and services.• Experienced in high-volume customer flow and secure cash handling.

Master Of Business Administration - Mba, Business Administration And Management, General

Bachelor Of Science (Bs), Business Administration And Management, General