Enhanced claim processing efficiency by thoroughly reviewing and analyzing documents submitted for each case.Provided top-notch customer service throughout the claims process, ensuring a positive experience for policyholders and reinforcing brand reputation.Expedited claim resolutions through effective communication with clients, providers, and other stakeholders.Managed high-volume caseloads while consistently meeting deadlines and maintaining quality standards for claim submissions.Improved customer satisfaction ratings by providing prompt and accurate responses to inquiries regarding claim status.

Bill and collect on major medical claims for home infusion, ambulatory infusion, and/or specialty pharmacy. Complete and submit all necessary claim forms and electronic claims to process them in accordance with the timely filing requirements set by all third-party payors. Efficiently utilize all functions of the company's software applications (CareTend), including maintaining accurate and detailed charts and notes. Ensure posting accuracy through careful review of Electronic Remittance Advices (ERA). Execute roles as a remote team member with high production. Provide all necessary documentation required to expedite payments, including, but not limited to, demographic, authorization/referrals, National Provider Identification (NPI) number, and referring physicians. Verify that payments received are correct and according to company’s fee schedules, and that claims are processed correctly against billing and industry standards and regulations and match our contract agreements with individual providers.

Adapted teaching methods and instructional materials to meet students' varying needs and interests. Contributed to potential new hire interviews by occupying a panel seat. Established and enforced rules for behavior and procedures by building and maintaining relationships with students, parents, teammates, and administration. Establish clear objectives for all lessons, units, and projects, and communicate these objectives to students. Prepared objectives and outlines for courses of study, following curriculum guidelines and requirements of states and schools. Prepared students for later grades by encouraging them to explore learning opportunities and to persevere with challenging tasks.

Received recognition for achieving exceptional consistency among accuracy and customer service quality reviews. Perform efficient and effective tasks by carrying out assignments in a remote setting. Develop and implement risk-assessment models or methodologies. Gather medical, financial, occupational, and avocation histories for life insurance applicants, combined with risk-related data from internal and external resources. Maintain input and data quality of risk management systems. Review and edit information collected during the interview for quality assurance purposes. Utilize the Risk Management System and Phone Dialer System to make telephone calls, log call attempts, document information within orders as necessary and record call results.

Analyze information gathered by investigation and report findings and recommendations. Examine claims forms and other records to determine insurance coverage. Investigate, evaluate, and settle claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio. Pay and process claims within designated authority level. Verify and analyze data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures.