Tuua Teleni
Atwater
Summary
Results-driven Healthcare and Operations Professional with over 15 years in healthcare claims, business analysis, and operational processes. Expertise in analyzing complex data, identifying trends, and developing strategic solutions. Demonstrated capacity to thrive in fast-paced environments while ensuring accuracy and delivering exceptional customer service.
Overview
35
35
years of professional experience
Work History
Business Analyst
United Healthcare Group - OPTUM Rx
Cypress, CA
06.2017 - Current
- Analyzed, reviewed, forecasted, and trended complex data to inform operational and business decisions.
- Support short- and long-term operational and strategic business initiatives through detailed data analysis.
- Research business issues and develop recommended solutions based on data and process analysis.
- Researched business issues and developed data-driven solutions to address identified challenges.
- Participated in implementing business solutions and process improvements to enhance operational effectiveness.
- Take an active role in internal training and knowledge sharing.
- Review and provide guidance on inquiries related to Medicare Part D M&R claim adjudication.
- Apply strong attention to detail and analytical skills when reviewing complex healthcare claims and business information.
IHSS (In-Home Support Services) Provider
ORANGE COUNTY, CA
06.2023 - 07.2026
- Supported recipient with essential household tasks to promote comfort and independence.
- Assisted with transportation in and out of vehicles for medical and shopping needs.
- Organized groceries and household items to ensure efficient storage and retrieval.
- Supported mobility, transfers, and repositioning to reduce fall risk and discomfort.
- Monitored medication schedules and reminded clients of prescribed routines.
- Performed basic household chores such as cleaning and laundry to maintain a clean, comfortable, and organized living environment for clients.
- Performed laundry, grocery shopping and other light housekeeping duties as instructed by client.
Recovery/Resolutions Analyst
United Healthcare Group - OPTUM Rx
Cypress, CA
12.2007 - 06.2017
- Investigated and resolved member and provider claims for health plans and government entities, enhancing claims accuracy and compliance.
- Supported accurate and timely resolution of complex claims and recovery issues.
- Contacted pharmacies and healthcare providers to gather coordination of benefits information, ensuring correct claim processing.
- Processed recovery claims and performed claim-related adjustments and transactions.
- Executed claim macros, reprocessed claims, and completed claim reversals.
- Ran claim macros, reprocessed claims, and completed claim reversals as required.
- Facilitated accurate and timely resolution of complex claims and recovery issues, contributing to improved member satisfaction.
Medical Insurance Entry/Biller Clerk
KAISER PERMANENTE
Honolulu, HI
01.1997 - 07.2007
- Updated medical insurance claims and maintained accurate computer records to ensure timely processing.
- Posted payments and adjustments accurately.
- Reconciled reports and reviewed information for accuracy.
- Resolved incoming customer inquiries by researching issues and providing clear explanations.
- Addressed insurance and billing-related questions to enhance customer understanding and satisfaction.
- Processed insurance claims, applying payer guidelines to ensure accurate reimbursement.
Food Preparer, Cook & Cashier
LITTLE CAESAR'S RESTAURANT
Honolulu, HI
01.1992 - 01.1997
- Maintained restaurant cleanliness and appearance to enhance customer experience.
- Responded to high volumes of customer inquiries over the phone.
- Prepared pizzas, dough, and toppings according to Little Caesars quality standards.
- Monitored food inventory and restocked ingredients to support steady kitchen operations.
- Operated conveyor oven and maintained consistent baking times for product quality.
- Followed food safety, sanitation, and cross-contamination procedures during meal preparation.
- Assembled orders accurately to meet customer specifications and service expectations.
- Cleaned prep stations, equipment, and work areas to maintain safe kitchen conditions.
- Coordinated workflow during busy periods to reduce delays and keep service moving.
- Trained new team members on prep procedures, speed, and quality standards.
- Enhanced customer satisfaction with quick and accurate food preparation, ensuring timely service.
Education
High School Diploma -
James Campbell High School
Ewa Beach, HI06-1992
Skills
- Business & Data Analysis
- Data analysis
- Business Process Analysis
- Healthcare Claims & Adjudication
- Claims Recovery & Resolution
- Forecasting
- Process improvement
- Research & Problem Solving
- Operational Support
- Microsoft Office Suite
- Microsoft Teams & Outlook
- Strong Communication Skills
- Team collaboration
- Training & Knowledge Sharing
- Team collaboration
- Healthcare communication
- Strategic planning
- Process improvement
Timeline
IHSS (In-Home Support Services) Provider
ORANGE COUNTY, CA
06.2023 - 07.2026
Business Analyst
United Healthcare Group - OPTUM Rx
06.2017 - Current
Recovery/Resolutions Analyst
United Healthcare Group - OPTUM Rx
12.2007 - 06.2017
Medical Insurance Entry/Biller Clerk
KAISER PERMANENTE
01.1997 - 07.2007
Food Preparer, Cook & Cashier
LITTLE CAESAR'S RESTAURANT
01.1992 - 01.1997
High School Diploma -
James Campbell High School