A self motivated professional with strong leadership, organizational, problem solving, interpersonal and communication skills. Dedicated and focused; able to prioritize and completed multiple tasks, and follow through to achieve project goals. Recognized as detail oriented, creative and loyal with an exceptional ability to work well with other teammates of all ages. Loves a challenge!

1. TONI M. GAGNON Phone: 920-360-3551 Email: 1962tonig@gmail.com
2616 Park Front Way • Green Bay, WI 54301 • www.linkedin.com/pub/toni-gagnon/19/774/974
SUMMARY
A self motivated professional with strong leadership, organizational, problem solving, interpersonal and
communication skills. Dedicated and focused; able to prioritize and completed multiple tasks, and follow through to
achieve project goals. Recognized as detail oriented, creative and loyal with an exceptional ability to work well with
other teammates of all ages. Loves a challenge!
EXPERIENCE
Network Health Insurance, Menasha, Wisconsin 2015-present
Medicare Health Care Concierge/ Network Cares Specialist for Special Needs
• Responsible for assisting elderly and Special Needs plan members with questions about Medicare Advantage,
Medicaid and explaining their benefits. Writing up intakes for new members and assigning to case managers.
• Answering phone calls and emails from members, POA’s or Guardians, case managers, social workers, nurses,
pharmacy’s and providers with troubleshooting claims, answering benefit questions and helping to resolve any
errors that have occurred by contacting the providers on behalf of the member to get it corrected.
• Accurately document calls with detailed information
• Assist with ordering Dental cards and making appointments
• Assist with Pharmacy claims
• Also performs administrative duties including handling incoming and outgoing mail, telephone inquiries, and
faxes from members, agents and providers. Meets personally with members as needed.
STREU’S PHARMACY, Green Bay, Wisconsin 2014-2015
Long Term Care Pharmacy Technician/ Biller
• Assists pharmacists in preparing and dispensing of medications in the Long Term Care (LTC) Pharmacy.
• Responsible for packaging prescription medications according to pharmacy standards.
• Demonstrates accuracy and thoroughness. Utilizes strong quality practices to maintain accuracy and integrity
in filling prescriptions. Protects patient confidentiality while processing patient information.
• Leadership role on the Lean and 5S team to help organize the Store and the pharmacy
SHOPKO STORES - Shopko Institutional Care (A Long Term Care Pharmacy), Green Bay, Wisconsin 2012-2014
RxCare Billing Specialist
• Responsible for processing payments and claim reconciliation. Prepares various pre-billing and post-billing
reports, bills and statements. Processes prescriptions to appropriate third parties for payment. Communicates
directly with insurance companies to resolve claims.
• Submits invoices directly to the state Medicaid agency for non-dual eligible residents and for medications not
covered by Medicare Part D
• Successfully resolved rejected claims and unbilled claims which saved the company money.
• Worked with the ADRC or social workers to assist residents or their family members with Part D,
Commercial insurance or Medicaid to resolve billing issues.
Network Health Insurance, Menasha, Wisconsin 2009-2012
Health Care Concierge/ Network Cares Specialist/ SNP Team
• Responsible for assisting members with questions about Medicare Advantage, and problem solving claim
issues. Also performs administrative duties including handling incoming and outgoing mail, telephone
inquiries, and faxes from members, agents and providers. Meets personally with members as needed.
• Worked with Special Needs Plan members, social workers, and team nurses to assist with and successfully
resolve Medicare and Medicaid issues.

2. Humana Insurance, Green Bay, Wisconsin 2008-2009
Provider Network Operations Specialist
Responsible for resolving claims issues involving provider edits to ensure timely adjudication while maintaining high
standards of production and quality.
• Consistently surpassed quality standards achieving 99.7% - 100% quality ratings.
• Utilized professional phone communication skills to call providers effectively collect missing
provider information.
United Healthcare Insurance Company, Green Bay, Wisconsin 2006-2008
Team Lead, Customer Service Associate and Subject Matter Expert (SME)
Promoted to the Team Lead position. Responsible for problem solving situations, and advising and educating callers,
in the Medicare Part D call center. Supports supervisor and teammates with escalated supervisor calls, staff training
and administrative duties, as required.
• Chosen to assist Prescription Solutions Pharmacy Help Desk, updated member’s subsidy levels, processed
mail orders, and assisted pharmacies, as needed.
• Consistently achieved 100% quality on calls.
• Subject Matter Expert in Medicare Part D, Medicare and Medicaid issues.
• Selected, out of 500 associates, to represent the company at the AARP Conference in Boston.
WEL Trucking Company, Green Bay, Wisconsin 2005-2006
Data Entry/Delivery Clerk
• Responsible for making sure deliveries and pickups were scheduled on a timely manner.
• Assisted with administrative duties, truck driver’s mileage logs and other paperwork, as required.
Baylake Bank, Green Bay, Wisconsin 2003-2004
Customer Service Representative/ Teller
• Responsible for handling deposits, withdrawals and loan payments while following privacy laws.
• Balanced large amounts of cash with excellent accuracy.
Bartelt Business Machines, Green Bay, Wisconsin 1987-1990 & 2002-2003
Administrative Assistant/Sales Clerk/Customer Service Representative
• Responsible for administrative duties including ordering, pricing, and stocking office supplies and equipment.
• Sold typewriters, fax and copy machines.
• Responsible for scheduling service and sales calls; and preparing billing quotes.
• Also served as bookkeeping / accounts receivable and payable clerk.
ADDITIONAL EXPERIENCE
Piano / Vocal Teacher, Singer and Musician
Responsible for managing all aspects of the business for over 30 years. Schedules students, organizes recitals, and
utilizes talents to creatively and patiently teach students while having fun.
EDUCATION
University of Wisconsin - Green Bay
Studied Music Education and Vocal Performance
TRAINING / SKILLS
• Numerous classes regarding: Manager Training, Food Safety, Insurance Licensing and Principles of Banking
• Knowledge of Medical Terminology, Medicaid and Medicare Part D
• Pharmacy Tech • Medical/Patient Confidentiality (HIPAA) • Typing (up to 70wpm)
• Lean Six Sigma, 5S Workplace Organization Team & Leadership
• Software: Proficient in Microsoft Office 2000, Word, Excel, PowerPoint & Outlook. Lotus, Facets, TMG
Call, QNXT, Quickbase, RX Claims, Doccutrack, Framework & Accpac