Bryan Roy Email & Phone Number

• Responsible for complex and thorough investigation of appeals, external complaints, and fair hearing review• Resolved appeal requests prior to committee or fair hearing review, when appropriate, including collaboration internally with all levels within the organization including Executives, Market Segment Leaders, Medical Directors, Legal, Medical Operations, Enterprise Operations, Customer Service, and leaders throughout the organization and externally with providers, agents, members, and employer groups• Provided education and communicated training needs to Customer Service Leadership, when appropriate, to avoid unnecessary appeals and/or expedited requests

Grand Rapids, Michigan, United States

• Met production and quality-based measures set by the employer• Utilized Facets Inquiry Tracking systems to initiate and resolve claim related issues• Processed commercial claims through on-line adjudication

Grand Rapids Metropolitan Area

• Assist and educate members, employer groups, and colleagues, of health plan benefits • Facilitating and resolving complex problems, understanding claims, billing, and coding, along with other non-routine questions.• Creating an exceptional experience with each contact, via inbound and outbound calls, face-to-face interactions, chat, and email

• Produced benefit letters for members• Checked to ensure that appropriate changes were made to resolve customers’ problems• Contacted members in order to respond to inquiries or to notify them of claim investigation results and any planned adjustments• Kept records of customer interactions and transactions, recording details of inquiries, complaints, and comments, as well as actions taken

• Educated member’s on medical policies and additional resources Priority Health offers• Skilled with Medicaid, Commercial, and Individual plans• Processed premium payments for Individual plan members

HR Duties:• Organized drug screens, employment verification's, background checks, and reference checks• Followed-up with on-boarding documents and ensuring candidates are completing documents within a 24-48-hour period• Obtained W2’s and pay stubs for employers if neededRecruiter Duties:• Data Entry• Sourced job boards and internal system (Bullhorn) to find qualified candidates• Created job postings to attract qualified candidates via Zip Recruiter, Career Builder, Monster, and Indeed

Big Rapids

• Verified the professional licensing, training, and certifications of professional medical staff to ensure healthcare professionals comply with all established regulations and guidelines• Assisted in interpretation and enforcement of Medical Staff Bylaws and Joint Commission standards and provide guidance to Medical and Dental Staff when necessary• Reviewed credentials, files, and ran reports for potential red flags• Assisted in organizing patient and provider activities

Big Rapids, Mi

• Spoke with prospective students and families about all areas of the University• Answered phones and provided referrals• Coordinated events to engage students in team building• Led Groups ranging from 10-50 people around campus• Made 25 cold calls a week to prospective students and their families

Big Rapids, Mi

• Assisted students registering for classes• Showed families around campus• Coordinated Events• Gave presentations on topics related to transition to college