My resume! Strong Contract Negotiator was my prior position at Aetna.

1. 444 West Middle Trnpke
70U
Manchester, CT. 06040
(860) 335-9624
Sherpeach224811@cox.net
Sher S. Gilmartin
Seeking a challenging position that allows me to contribute my skills
Objective
and experience for growth opportunities
• 11 years' experience in a corporate insurance company which has given
Areas of me many skills and an excellent background ranging from customer s
Expertise service to contracting.
• Managed medical contracting and negotiating for North Central and
Behavioral Health nationally.
• Saved 3.7 million dollars in 2008
• Helped implement new ways for claims to process more efficiently by re-
loading claims and based on the situation which resulted in requesting
new pay or denial codes.
• Recruited physicians, providers, and facilities to be part of a Workers
Compensation Network including negotiating and contracting.
• Held demos for plan sponsors to provide information as to how they were
loaded within the computer system to provide information to their
customers.
• Trained to process all medical specialty claims
• Working knowledge of Traditional and HMO products
• Extremely productive in a high volume, high stress environment with a can
do attitude.
• Proficient in Windows XP, Word, Excel, Microsoft Office and Microsoft
Access.
Experience Contract Negotiator, Aetna, Inc.
• Design, develop, contract, maintain and enhance 2007-2009
relationships with facilities, physicians and ancillary providers
which serve as contractual networks of care for members;
foster growth of managed care products; and enhance
profitability.
• Investigates the resolves issues surrounding pre and post
negotiated claim/bills.
• Works with all departments to obtain information such as
plan benefits and insured liability to follow the negotiation
process.
• Contacts the provider via-phone and fax as set forth under
the established guidelines.
• Reviews claims/bills to initiate Long Term Agreements and
Master Contracts.

2. Provider Recruiter, Aetna, Inc.
• Negotiates recruits and executes physician contracts in 2005-2007
accordance with company standards in order to maintain and
enhance provider networks while meeting and exceeding
accessibility, quality, and financial goals.
• Mastery of provider contracts, contracting options, PADU
guidelines as well as provider configurations.
• In-depth knowledge of the managed care industry and
practices, as well as a strong understanding of competitor
strategies, practices, and financial/contracting arrangements.
• Provides support with network development, maintenance
and refinement activities to further the effectiveness of cross-
market network management.
Service Consultant, Aetna, Inc.
Medical insurance, Flexible Spending Accounts and Health 2000-2005
care Savings Accounts
• Handles telephone and written correspondence from varied
source (providers, members, plan sponsors and attorneys.
Also reviews claims cost payments in order to respond t o all
requests for reconsiderations or appeal.
• Perform a wide variety of customer service and related
functions, including phone calls, written inquiries, out reach
programs, and walk-ins. Explained customer/member
specific plan of benefits along with member’s responsibilities
in accordance with contracted arrangements.
• Reviews and adjudicates complex, sensitive, and/or
specialized claims in accordance with claim processing
guidelines.
• Responsible for managing complex claim research scenarios
and serving as a technical resource to colleagues on claim
resolution, triaging of claim pre-authorization issues, and
similar situations requiring senior level expertise.
Claim Benefit Specialist, Aetna, Inc.
• Achieve superior claim and member service performance 1997-2000
through an integrated process of operational, quality, medical
cost, and resource management meeting and/or exceeding
member, plan sponsor, and provider expectations.
• Analyzes and approves claims that cannot be auto
adjudicated.
• Proofs claim or referral submission to determine, review, or
apply appropriate guidelines, coding, member identification
processes, provider selection processes, claim coding,
including procedure, diagnosis and pre-coding requirements.
• Utilizes all applicable system functions available ensuring
accurate and timely claim processing service.
Manager, Battistons
West Hartford and Manchester 1995-1997
• Managerial duties.
• Trained new staff on job responsibilities.
• Responsible for opening/closing store.
• Resolved customer conflicts and complaints.

3. 2005-2007
Western International University, Associates in
Education Business
1990-1993
High School Diploma, West Hartford
Interest Softball, Beach