Ronald J Garay Email & Phone Number

Minnetonka, Minnesota, United States

- Subject matter expert for issues relating to member services - Responsible for tracking call center volumes, distribution levels, and quality assurance- Assesses plan/program errors and provides innovative solutions - Works with leadership in creating metrics to ensure highest quality assurance- Collaborates with other United Healthcare business segments for cross-training, staffing, and QA- Develops and leads trainings on new project initiatives- Develops and maintains Standard Operating Procedures - Responsible for training and mentoring new team members- Works with I.T. in piloting new software programs- Maintains and distributes daily goal report to team members- Serves as a team lead for the department

- Provided premium level service by providing end-to-end resolution for members- Responsible for consumer inquiries and issues by identifying the topic and type of assistance the caller needs such as benefits, eligibility, claims, financial spending accounts, correspondence, OptumRx Pharmacy, Optum Behavioral Health and self-service options- Advocated and intervened with care providers on behalf of the member to assist with appointment scheduling, billing concerns, and coverage determinations- Assisted the member with resolution as their advocate with 3rd party vendors- Researched complex issues across multiple databases and work with support resources to resolve member issues and/or partner with others to resolve escalated issues- Exceeded the performance goals established for: conversation effectiveness, call quality, member satisfaction, first call resolution, efficiency and attendance

Miami, Florida, United States

- Assisted the Manager of Enrollment with staff management, addressing performance andattendance issues as appropriate- Directed, reviewed, and monitored the Enrollment reconciliation operation withefficiency and effectiveness- Directed the revision and implementation of internal departmental systems andprocedures- Reported and monitored the daily, weekly and monthly inventory reports todetermine departmental efficiency - Worked with leadership in the strategic future planning of the enrollment function- Ensured that prospective enrollees are appropriately screened to meet eligibility requirementswithin regulatory timelines- Led the enrollment team to ensure timely and accurate completion of all required eligibilitydocuments, accurate recording of assessments, and guaranteeing productivity standards- Led and coordinated interdepartmental projects with other areas of the organization;including Retention, IT, Marketing departments, Compliance, and Provider Relations- Worked closely with the Sales and Compliance teams to ensure timely submissions andresolution of eligibility issues- Analyzed workflows, identified deficiencies, and developed more efficient processes- Prepared enrollment analysis and enrollment reports for the Director of Enrollment- Served as a subject matter expert and coordinating departmental procedures

Miami, Florida, United States

- Responsible for preparing, processing and maintaining new member or group enrollments- Loaded new member or group data into the enrollment database & update the database with changes- Responded to member eligibility or group questions & enrollment statuses- Responsible for reconciling eligibility discrepancies, analyzing transactional data & submitting retroactive eligibility changes- Served as primary contact as it relates to all enrollment tasks for assigned book of business- Maintain satisfied customers by providing superior service and practice attention to detail - Maintained established procedures to maintain enrollment data in applicable systems and databases - Responsible for ensuring team members meet or exceed departmental established productivity, quality, and turn-around standards- Worked with leadership in managing, prioritizing and delegating workload- Served as a mentor for peers to ensure group customer expectations were attended to and that member data was accurately reflected in enrollment system at all times- Responsible for moderately complex error reports, analyzing member enrollment data, and maintaining enrollment system(s) based on findings- Resolved customer inquiries as they relate to enrollment and eligibility through all lines of communication

Miami, Florida, United States

- Maintained productivity and quality metrics- Worked with various types of member correspondence- Researched benefits and eligibility using proprietary systems- Made outbound calls to providers, insurance, and patients to obtain benefit/eligibility information

Miami, Florida, United States

- Ensured proper claims processing policies and procedures were applied- Participated in piloting new systems in testing environments - Monitored daily metric goals and assisted peers- Worked closely with providers and members to resolve claim discrepancies- Responsible for maintaining claims information based on meticulous research

Bachelor Of Arts - Ba, Supervision And Management

Associate Of Arts (A.A.), Graphic Communications

High School Diploma