Malia Sanu
Clinton,MD
Summary
Professional with strong background in case management, prepared to make significant impact. Proven ability to collaborate with teams and adapt to changing needs. Skilled in client assessment, resource coordination, and crisis intervention. Reliable and results-focused, with commitment to achieving positive outcomes.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Case Manager
ConnectiveRx
Pittsburgh, PA
11.2024 - 12.2025
- Takes the lead to manage the Care Coordination process within an assigned territory.
- Establishes and maintains professional and effective relationships with all internal and external customers (i.e., care coordination colleagues, care field team, patient advocacy groups, insurance company case managers, specialty pharmacies, physician office staff and office coordinators) while multitasking to coordinate, evaluate and advocate for options and services to meet the client’s needs.
- Coordinates the exchange of all patient-related information with internal and external customers (i.e., patients, families, healthcare providers, insurance companies, and specialty pharmacies).
- Effectively manages database including data on each individual, their insurance, coverage approvals, on-going coverage requirements and all patient and provider interactions.
- Keeps up to date with reimbursement process, billing/coding nuances, insurance plans, payer trends, financial assistance programs, charitable access, related resources, regional level and alternative resources.
- Assists in obtaining insurance approvals/denials and/or appeals for therapy.
- Assists patients and HCP with processing applications for Copay Assistance/Reimbursement and Patient Assistance Programs. Assists with ordering/triaging prescriptions for patient or HCP.
Claims Examiner
UPMC Health Plan
Pittsburgh, PA
10.2019 - 02.2021
- Assist other departments during periods of backlogs;
- Process MCNet/Batch Edit errors in accordance with designated standards;
- Identify areas of concern that may compromise client satisfaction;
- Maintain mail date integrity;
- Process 10 to 15 standard to moderate claims an hour, including COB, in accordance with company policies and procedures in a timely manner while meeting or exceeding production and quality standards;
- Resolve outstanding holds in accordance with designated standards;
- Effectively prioritize and complete all assigned tasks
Provider Advocate
UPMC Health Plan
Pittsburgh, PA
06.2018 - 10.2019
- Actively maintain worklist open cut logs and follow up within the designated time standards.
- Assist with adjustments in accordance with company policies and procedures.
- Identify any area of concerns that may compromise client satisfaction.
- Interface with customers by telephone or correspondence to answer inquiries and resolve concerns.
- Maintain employee/insured confidentiality.
- Maintain or exceed designated quality standards.
- Participate in team meetings, provide ideas and suggestions to ensure client satisfaction and promote teamwork.
- Provide assistance to other departments during periods of backlogs.
- Quality customer service
- Knowledge of medical terminology, ICD-p, ICD-10 and CPT Coding
- Assists HCP with processing applications for Copay Assistance/Reimbursement and Patient Assistance Programs.
Caregiver
Home Nursing Agency
Pittsburgh, PA
11.2014 - 06.2018
- Assist elderly with everyday tasks, such as meal preparation and medication reminders.
Benefits Verification Specialist
AmerisourceBergen Lashgroup
Monroeville, PA
10.2017 - 01.2018
- To be the preferred partner to healthcare providers and pharmaceutical manufacturers.
- To improve patients’ lives by delivering innovative products and services that drive quality and efficiency in pharmaceutical care.
Customer Service Representative
IBEX Global
Pittsburgh, PA
05.2017 - 10.2017
- Listen to and understand customer issues
- Probe and isolate issue causes
- Utilize available resources to identify appropriate solutions for customers
- Explain product features and benefits, answering questions and setting proper expectations for customer inquiries
- Ensure customer satisfaction through effective call resolution
- Identify and escalate emerging product or customer dissatisfaction issues
Food Service Attendant
UPMC
Pittsburgh, PA
09.2016 - 04.2017
- Timely assembly, final preparation and service of nutritionally-appropriate and attractive meals.
- Practices appropriate food handling techniques and food safety procedures in all aspects of job.
- Demonstrates excellent customer service skills on a consistent basis.
Education
Associate of Arts - Business Administration – Marketing And Management
Institute of Medical And Business Careers
Online05.2026
High School Diploma -
City Charter High School
Pittsburgh, PA05.2012
Skills
- Microsoft Office
- Time management
- Case documentation
- Active listening
- Organization and multitasking
- Documentation and reporting
- Decision-making
- Conflict resolution
- Data entry and analysis
- Social work
- Clear communication
- Team collaboration
Certification
- First Aid Certification
- Licensed Esthetician (Current)
- CNP - Certified Notary Public
Timeline
Case Manager
ConnectiveRx
11.2024 - 12.2025
Claims Examiner
UPMC Health Plan
10.2019 - 02.2021
Provider Advocate
UPMC Health Plan
06.2018 - 10.2019
Benefits Verification Specialist
AmerisourceBergen Lashgroup
10.2017 - 01.2018
Customer Service Representative
IBEX Global
05.2017 - 10.2017
Food Service Attendant
UPMC
09.2016 - 04.2017
Caregiver
Home Nursing Agency
11.2014 - 06.2018
Associate of Arts - Business Administration – Marketing And Management
Institute of Medical And Business Careers
High School Diploma -
City Charter High School