Samm Ramirez Email & Phone Number

Sacramento, Ca, Us

Rancho Cordova, California, United States

Rancho Cordova, California, United States

Folsom, California, United States

Progressed from Claims Supervisor to Claims Manager in April 2019 to extend leadership and management expertise to our Stop Loss Reinsurance, Third Party Subrogation and Provider Network Negotiations Department and Auditor. Additional responsibilities encompass comprehensive analysis of reinsurance polices specific to carrier to determine and document anomalies from industry standard. Participate in attorney/client correspondence as a mediator between the plan and attorney for TPL liens. Non-participating provider outreach to negotiate pricing for out-of-network claims as a single case agreement or induction to our BRMS provider network. Enhanced procedure and documentation surrounding the claims appeal process flow. Implementation of the TIPS ticketing system for Customer Support escalations related to claims review. Overall analysis, maintenance, forecasting and Executive Management reporting of all claims related statistics.

Folsom, Ca

Managed a team of 33 claims examiners to guide lead and mentor in claims related industry best practices. Manage claims side of all implementations, including benefit review, coding and compliance. Responsible for the development and preservation of network contract partnerships with Anthem, ClaimDoc, Cigna, MedWatch, Smart Data Solutions and Zelis by managing inventory and data feeds. Provide on-going support and mentorship to the Client Management, Customer Support, Sales and Implementation teams as the resident expert.

Folsom, Ca

Progressed from a Client Coordinator administrative support position to Client Manager, Implementation Specialist and ultimately Account Executive that managed a book of business that resulted in 2.2 million dollars of revenue annually. Essential responsibilities included, however were not limited to an annual review of account services to identify additional sources of revenue for the account by offering new service opportunities. Formulating and implementing strategic business plans specific to the needs of individual clients for account retention. Developed strong business relationships with clients and producers to become a trusted industry source. Provided on-going education to clients on industry and price trends in order to inform and assist with plan benefit decisions. Monitored and managed all client implementations assigned to my book of business. Conducted monthly and/or quarterly face-to-face meetings and/or visits with clients to review plan performance and address service goals and any concerns. Supported, trained and mentored a team of 9 individuals on their overall development with an emphasis on resolution of escalated issues and review of prevention possibilities to ensure they did not repeat.

Promoted from temporary to permanent status in April of 2008; provided clerical support to Account Managers and Insurance Benefits Brokers: performed data entry; received and processed employee health benefit applications; reviewed applications for accuracy and completeness; researched information to complete forms; verified employee eligibility; submitted applications on-line to Dedicated Group Representatives and Health Benefit Carriers; liaised between Human Resource personnel and Health Benefit Carriers to ensure employee coverage; input demographic and enrollment information into the EPIC CaseTrac database; updated employee records during open enrollment; generated an Employee Census Report; worked with Human Resources concerning discrepancies to ensure employee participation and coverage during the open enrollment process.

Folsom, California, United States

Progressed from handling office maintenance to office management, expense reports and Diner’s Club Administration responsibilities in a fast paced environment: interviewed, hired, trained and supervised employees to ensure reception and office maintenance coverage; reviewed employee performance; researched information and maintained vendor relationships and contracts; prioritized office responsibilities; handled business correspondence for the Chief Executive Officer and the Chief Operating Officer; scheduled executive meetings and appointments; received, approved and input Employment Expense Reports; obtained managerial approvals; matched checks to the expense reports; investigated and resolved discrepancies; provided customer service to consultants; issued, suspended and cancelled company issued employee Diners Club credit cards; tracked spending habits; reconciled employee payments on unauthorized expenditures.

Santa Clara, California, United States

Supervised an outsourced call center team; provided employee trainings and PowerPoint presentations; ensured quality customer service was provided and that representatives met call volume quotas; handled business correspondence; responded to and forwarded e-mail; obtained preferential rates from couriers, distributors and vendors; answered multi-line telephone; handled problems and complaints.