Ashley Mathre
Lakeville,MN
Summary
Dynamic healthcare operations specialist with over 15 years of experience in Medicare, specializing in pharmacy appeals, prior authorization, CMS compliance, and comprehensive provider and member support. Demonstrates a proven track record of award-winning performance driven by analytics-focused issue resolution and meticulous documentation accuracy while navigating complex CMS and internal UHC systems. Proficient in guiding brokers, resolving escalations, identifying process gaps, and enhancing workflow efficiency across various Medicare business lines. Committed to delivering exceptional service and optimizing operational effectiveness in a fast-paced healthcare environment.
Overview
16
16
years of professional experience
1
1
Certification
Work History
Broker Agent Service Senior Representative
UnitedHealthcare
06.2025 - Current
- Provided high-volume inbound phone support to licensed insurance agents and brokers nationwide regarding UnitedHealthcare Medicare and Retirement products
- Serve as a subject matter expert on Medicare and Medicaid guidelines, including eligibility, enrollment periods, coordination of benefits and dual-eligible considerations
- Assisted agents with Medicare application intake, processing corrections and status updates, ensuring accurate and timely submission through CMS systems
- Support agent contracting and onboarding processes. Including appointment status, credentialing status and requirements, certification and training and compliance documentation
- Ensures adherence to CMS regulations, PHI requirements, HIPAA regulations and UnitedHealthcare policies and procedures on all broker and client interactions
Planned Work Sabbatical
02.2023 - 06.2025
- Delivered compassionate full-time support to family members using excellent time and task management to meet all needs.
Owner/Daycare Provider
Happy Feed Daycare, LLC
01.2016 - 01.2023
- Delivered compassionate care for up to 12 children at a time, upholding all laws and regulations in daily operations and reporting
- Built and maintained strong working relationships with all stakeholders, engaging in diplomatic issue resolution and professional etiquette
- Developed and delivered standard-aligned and developmentally appropriate activities for engaging and safe growth
- Maintained a strict budget and all supporting documentation with fiscal responsibility for ongoing profitability
- Developed and implemented operational policies to enhance daycare efficiency and client satisfaction.
- Managed staff recruitment, training, and performance evaluations to build a skilled team.
Administrative Assistant
Northland Business Systems
01.2015 - 04.2016
- Provided meticulous and organized administrative assistance to all employees using strong task prioritization to meet key deadlines
- Processed all accounts receivable and accounts payable
- Managed and updated website including product specifications
- Served as the face of the organization, providing friendly interaction with all clients in person and on the phone
- Completed all tasks with efficient processes to maintain smooth workflow and flexible response to all office needs
Broker Agent Service Senior Representative
United Healthcare (Contract)
04.2015 - 12.2015
- Supported Field Agents in selling Medicare and Retirement products, helping with explanation of all plan benefits
- Ensured agents were compliant with CMS and United Healthcare guidelines, staying up to date on all changes
- Processed Medicare and Retirement applications for benefits with exceptional time management skills
Pharmacy Appeal Analyst
UCare (Contract)
09.2014 - 01.2015
- Followed the prior authorization appeal process, collaborating with various departments for resolutions leveraging strong collaboration skills
- Investigated member appeals thoroughly using internal and vendor software with prompt efficiency
- Communicated resolutions verbally and in writing with accurate details and professional quality
Customer Service Representative
Ecolab
03.2014 - 09.2014
- Answered inbound calls from employees and dispatched to appropriate departments
- Setup extermination services for clients and routed the correct servicer
- Executed timecards and time off request from employees
Customer Service Representative
Hiway Credit Union
11.2012 - 03.2013
- Served up to 130 customers daily, representing the company and brand with a positive and welcoming demeanor
- Handled members accounts with accuracy and maintained all required documentation with precision
- Leveraged knowledge of products and services to meet the unique needs of clients and grow the business
Medical Receptionist
St. Paul Radiology
11.2010 - 04.2012
- Served physician’s office, providing comprehensive administrative services
- Utilized a strong understanding of medical terminology to process all requests with accuracy
- Engaged in professional communication with all patients and worked in partnership with all staff to ensure a successful experience for all
- Managed medical records and prior authorization for procedures
- Help implement a new EMR system
Pharmacy Prior Authorization Coordinator
Express Scripts (Contract)
05.2010 - 07.2010
- Controlled costs and improved outcomes through fast, efficient prior authorization processes
- Processed high volume prior authorizations by implementing a new streamlined workflow
- Collaborated with insurance companies to resolve prior authorization denials, increasing approved medications for patients
- Maintained accurate documentation of prior authorization requests and approvals, ensuring compliance with regulatory guidelines
Pharmacy Technician/Medicare D Prior Authorization Analyst
Prime Therapeutics (Contract)
10.2009 - 02.2010
- Managed pharmacy benefits and processed Medical D prescriptions with overrides in strict compliance with all policies, procedures, and HIPAA guidelines
- Communicated plan benefits and comprehensive claim adjudication information, working in retail and insurance environments with clear, concise correspondence, leveraging strong writing and listening skills to address unique needs and concerns
Education
Associate of Arts -
Inver Hills Community College
Inver Grove Heights, MN01-2019
Skills
- Case Investigation & Root‑Cause Analysis
- Data Interpretation & Trend Identification
- Workflow Optimization & Process Improvement
- SOP Development & Documentation Accuracy
- Project Coordination & Cross‑Functional Collaboration
Accomplishments
I was honored to receive the Steak is Great award alongside a select group of top‑performing team members. This recognition was based on my outstanding Voice of the Agent (VOTA) scores during the busy AEP season, where I consistently ranked among the highest for both performance and overall submitted VOTAs. As part of the award, I was invited to join department managers and directors for a special recognition dinner celebrating our contributions. This achievement reflects my strong commitment to service excellence, agent advocacy, and maintaining high-quality support during peak volume periods.
Certification
Former Certified Pharmacy Technician (CPhT)
Timeline
Broker Agent Service Senior Representative
UnitedHealthcare
06.2025 - Current
Planned Work Sabbatical
02.2023 - 06.2025
Owner/Daycare Provider
Happy Feed Daycare, LLC
01.2016 - 01.2023
Broker Agent Service Senior Representative
United Healthcare (Contract)
04.2015 - 12.2015
Administrative Assistant
Northland Business Systems
01.2015 - 04.2016
Pharmacy Appeal Analyst
UCare (Contract)
09.2014 - 01.2015
Customer Service Representative
Ecolab
03.2014 - 09.2014
Customer Service Representative
Hiway Credit Union
11.2012 - 03.2013
Medical Receptionist
St. Paul Radiology
11.2010 - 04.2012
Pharmacy Prior Authorization Coordinator
Express Scripts (Contract)
05.2010 - 07.2010
Pharmacy Technician/Medicare D Prior Authorization Analyst
Prime Therapeutics (Contract)
10.2009 - 02.2010
Associate of Arts -
Inver Hills Community College