Primary Responsibilities:

Research complex issues across multiple databases and work with support resources to resolve customer issues and/or partner with others to resolve escalated issues.

Serve as a resource or Subject Matter Expert (SME) for customers.
Meet the performance goals established for the position in the areas of: efficiency, call quality, provider satisfaction, first call resolution and attendance.
Answer incoming phone calls from customers and identify the type of assistance the customer needs (i.e. benefit and eligibility, billing and payments, authorizations for treatment and explanation of benefits (EOBs).
Ask appropriate questions and listen actively to identify specific questions or issues while documenting required information in computer systems.
Intervene with care providers (doctor’s offices) on behalf of the customer to assist with appointment scheduling or connections with internal specialists for assistance when needed.
Assist customers in navigating Health source RI websites and encourage and reassure them to become self-sufficient to navigate and utilize web service.
Own problem through to resolution on behalf of the customer in real time or through comprehensive and timely follow-up with the member.

Skills and Competencies:
Communication – proactively addresses and manages conflict and disputes; work to achieve constructive resolution.
Analytical – Synthesizes complex or diverse information; Collects and researches data; Uses intuition and experience to complement data; Designs work flows and procedures.

Problem Solving – Identify and resolves problems in a timely manner; Gather and analyze information skillfully; Develop alternative solutions; Work well in group problem solving situations; Use reason even when dealing with emotional topics.

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Optum Health Management Services - Skills and Competencies: (continued)
Technical Skills – Assess own strengths and weaknesses; Pursue training and development opportunities often; Strive to continuously build knowledge and skills; and share expertise with others openly.
Planning/Organizing – Prioritize and plans work or project activities; Use time efficiently; Plan for additional resources; Set goals and objectives and develops realistic action plans.

Collaboration – Effectively build and maintain partnerships with clients, prospects and people at all levels across the company. Contribute to team and company success. Communicate and shares information with candor that builds trust and enhances relationships.

Sanctuary Recovery Residence – Pawtucket, RI - March of 2013 to August 2015

Title: Assistant Director of Operations

Objective: The successful start up of a community outreach program, developing a viable business model to provide a personalized pathway to independence for both homeless military veterans and civilians recovering from dual diagnosis; mental health and substance use disorders.

Duties / Responsibilites:

As the Assistant Director of Operations, my duties are to provide the required oversight through the utilization and review process. Create policy and procedures to enhance services, maximize efficiency, maintain fiscal discipline and cost containment. Implement reporting systems to track and monitor clinical, managerial and residential performance of day to day operations.

Perform residential admissions, transitions and discharge.
Perform recruiting and retention, community outreach, presentations.
Perform routine office management, project management, grant requests.
Provide individual case management to ensure continuous improvement through
personalized goal setting.
Establish and initiate a personalized pathway to independence for every resident.
Document residential and staff performance.
Ensure compliance with department of health and the departments of behavioral health guidelines as applicable to the proper function and operations of transitional housing units and or therapeutic based community-living facilities/domiciles’.
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Sanctuary Recovery Residence (continued)

Accomplishments:

As a founding member I provided the initial concept and business model. I provided the level of experience and professionalism required to minimize risk and expenditures and in turn yielded and exceed forecast results. I was solely responsible for creating the standard operating policies and procedures which brought to fruition the achievement of fiscal discipline, financial stability and eventual profit, as well simultaneously increasing quality standards within the industry in fulfillment of our mission statement “Setting a New Standard”.

Skills Utilized: Interpersonal skills, office management, leadership development skills, business management skills, oral presentations, negotiations, team building, creativity, adaptability, sales management, operations management and risk management.

Industrial Engineering Co, Inc. - Foxborough, MA 02035 - October 2009 to March 2013

Title: Project Estimator

Industry: Industrial sheet metal fabrication, aerospace and defense industries.

Duties / Responsibilities:

Prepare and deliver estimates for the production of military grade prototypes and inventory Items.
Complete estimates per “requests for quote” on military grade; missile defense components.
Communications, radar and structural based equipment.
Perform review of blueprints to determine the feasibility of the project.
Determine to "Bid" or "Not Bid" the request based upon the profit potential.
Perform materials list and break down (Take-off) from blue print.
Obtain quotes on purchased items such as special materials and hardware.
Establish vendor accounts with NADCAP approved sources, vendors and suppliers.
Ensure compliance with all applicable military standards and specifications.
Assess the estimated number of hours associated with each phase of; engineering, production, testing, inspection, outsourcing, fabrication, assembly, finishing, shipping and receiving of components in order to yield the estimated production cost.

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Industrial Engineering Co, Inc. - Duties / Responsibilites: (continued)

Utilize estimating software and established quote matrix to determine volume based pricing while maintaining profit margin.
Formalize data into a proposal for submission.
Submit quote, repeat process and principle with an average account work-load of 122 accounts.

Go Modular, Inc. - Lincoln, RI 02863 - October 2003 to January 2008

Title: Project Manager

Industry: Modular Erectors, Commercial and Residential Custom Modular Buildings.

Duties:

Complete project management from blue print to certificate of occupancy.

Risk Management, recruiting and retention of vendor’s suppliers and contractors. Logistics, planning, records, building permits, state inspections, stamps, certificates.

Field operations, weekly field inspections and daily progress reporting comprised to produce and track budget analysis and time lines.
Consults with engineers, architects, designers, clients, building officials and contractors, to ensure adequate progress, compliance and quality of every project throughout each phase of completion.
Utilization and review software tracking of multiple projects throughout the construction process. Maintain budgetary and progress reports on multiple accounts concurrently throughout completion.
Conduct performance review meetings with subordinate staff and field personnel.
Review project forecast and scheduled milestones and levels of completion.
General management of customer service, claims warranties and claims adjudicator, perform mediations, negotiations and concessions.
Facilitate contract specifications, budgets and deadlines with maximum efficiency and compliance of federal, state and municipal requirements.
Authorize invoice payments and cash disbursements accordingly.
Respond to federal, state and municipal officials, architects, designers and clients.
Create and initiate policies to enhance production, increase cost containment and ensure loss prevention.
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H&H Machine Providence, RI 02916 - January of 1990 to August of 1995

Title: Certified CNC Machinist

Industry: Manufacturing of precision parts and components.

Duties: Manual and CNC machinist and Set Up of the following; Okuma, Mazak, Citizen, Funuc controls, Swiss Tornos multi-spindle screw machines, Bridgeport, lathes and milling machines, Dovetail toolmaker, precision center-less grinding.

Quality and production control standards utilizing ISO, SPC, JIT, lean manufacturing via Six Sigma.

II. Professional Tasks & Achievements:

• Tasked with improving the efficiency and accountability within customer service, sales and design departments.

• Initial action was to establish existing performance baseline, assess deficiencies and initiate proactive solutions through policy and procedures.

• The enforcement of loss prevention and inventory control through real time tracking on inventory and a mandatory chain of custody within materials management.

• Establishment a customer service and claims tracking database to ensure accurate record of customer correspondence, Inquiries and reported claims.

• Provide a claims review process to accurately determine cause, Initiate preventative measures and provide claims resolution and corrective action in a timely manner.

• To reduce liability, minimize expenditures and increase quality, I initiated a subrogation process on applicable claims for third party liability along with statistical product controls to provide performance data and fiscal reporting.

• Initiate a customer survey to assist with Quality Assurance, OHSA, NCQA accreditation and customer satisfaction.

III. Certifications:

Secret Security Clearance Awarded United States Army Signal Corps. (expired).
Communications Encrypted Signal Support Systems Specialist, US Army Signal Corps.
EMT Certification state of Massachusetts (expired).
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III. Certifications: (continued)

Decorated US Army Military Police Officer, US Army National Guard.
Certified Ambassador and Customer Service Representative Blue Cross and Blue Shield of Rhode Island.
Certified Automotive Technician (expired).
Certified Operations Manager of Aspen Dental.
Certified Industrial Mechanic of Robin Rug.
Certified Greenbelt Six Sigma Lean Manufacturing for Raytheon Corps.
Certified Project Estimator of Industrial Engineering Manufacturers.
Journeyman Carpenter / Cabinet Maker of Local Union 94.

IV. Military Service:

Branch: United States Army Rank: E-5

I served as an encryption, satellite communications specialists. While attached to an infantry combat MP unit. I then cross trained over to become an MP where I served for nine years until receiving an honorable discharge.

Commendations:

National Defense Service Ribbon.
US Army Achievement Medal.
US Army Commendation Medal.
Military Police Academy, Top Honors Graduate, 1st in Class.
Recipient; Command Sergeant Major Martini Leadership Award.
Recipient of the Prybila Scholarship.
Graduate with Honors United States Army Signal Corps / Communication Specialist.

~Extensive employer reference list, BCI, high level US Military security clearance and personal references furnished upon request.

~Extensive education and accredited continuing education certificate, college and technical training information available upon request.