Alisha Leehan Email & Phone Number

Houston, Texas, United States

In charge of the daily morning grievance report – Enter all grievances into the data entry system and assign to grievance coordinatorUpload all incoming faxes into the daily folders and assist with intaking each provider dispute, provider/member appeal and assigning to appropriate coordinators for resolutionMonitor daily scanned mail and intaking each provider appeal/dispute, member appeals for the day and assigning to appropriate coordinator for resolutionAbility to multi task and be cross trained to assist other departments as needed

Houston, Texas Area

-Escalate and handle claim discrepancies and direct support to the proper departments for resolution and also responsible for additional research of provider contracts to determine if claims were processed appropriately and escalate any discrepancies to our claims supervisor for further adjustment. -Assist the appeals department with intake of incoming appeals on backlog and provide additional support and provide research for resolution. -Process all EOB/EOP requests daily for client service team via fax, email and/or Mail-Assist in processing credit card/bank draft premium payments and in charge of updating spreadsheets daily for record keeping-Adaptable to change and highly knowledgeable of all lines of business: Self-Insured, Fully Insured Commercial HMO/PPO groups and our Medicare Advantage Plans

Houston Tx

-Providing client services teams with feedback and coaching via regular one-on-one meetings, lead ongoing new hire training, ongoing client specific training, and lead annual open enrollment training for 5+ clients-Researching and working with client teams on carrier file escalations-Managed preparing life insurance claim paperwork to forward to appropriate carrier for processing and updating benefits via ESS (Employee Self Service) system timely-Responsible for processing QMCSO (Qualified Medical Child Support Orders) for multiple clients and updating employee benefits timely -Assist callers and act as liaison directly with insurance carriers on claims issues, insurance verification, new hire enrollments, life event enrollments, and dependent verification updates-Maintaining internal KnowledgeBase with client specific training tools and materials and implementing the database for all onboarding new clients-Ensure compliance with Federal, State and Local laws and ensuring all client service representatives are current with annual HIPPA certifications-Maintaining client relationships and analyzing operational workflow to ensure quality, quantity, and efficiency standards are met or exceeded

Houston, Texas Area

-Assist customers in a professional manner to resolve delinquency accounts in a high call volume outbound setting with the ability to multi task. -In charge of creating weekly spreadsheets on each collectors (30 collectors) individual performance as well as training new employees how to effectively work our departments' portfolio-Maintained a natural leadership approach while taking ownership on projects and tasks to create maximum results.