Oversee the day to day work functions of assigned areas. Provide support to staff and exercise cost control in order to accurately and timely process members medical claims.

Supervised assigned customer service functions at the health plan to meet overall business goals and objectives.Ensure the team meets its goals and objectives through effective hiring, performance management, coaching and career development. Act as the Complaints Coordinator; ensuring all complaints are resolved and responded to the appropriate partiesDevelop, implement and maintain materials and programs ensuring production and quality standards are met• Hire, motivate, coach, counsel, and supervise the daily functions of the provider services staff• Educate members regarding plan benefits as appropriateEvaluate and audit performance and identify and implement improvement opportunities to increase overall productivity and effectiveness• Review and respond to complex issues and questions* Ensure processes are compliant with contractual agreements and State and Federal regulationsAnalyze and advise management of personnel, work-flow issues and trends and recommend resolutions• Audit daily phone log reports and access the need for changesI also manage the RTA team (Real Time Adjustment Team) My responsibilities with this team include providing support to staff and exercise cost control in order to accurately and timely process members' medical claims/ Good Will Gesture, admin pays.Assess and allocate work volumes on a daily basis.Special project work as assigned.Ensure task completion and performance goals are met, such as Quality, Adherence, service levels• Identify and resolve operational problemsAccountable for daily/weekly/monthly activities of all team members. Help with claims questions and assist the team with their growth and development with ther claim skils and knowledge

Assist in coordinating the day-to-day work function of the assigned claims unit, provide technical support to staff, and investigate, review and resolve complex issues. Assist in reviewing investigating, adjusting and resolving complex claims, claims appeals, inquiries, and inaccuracies in payment of claims Assists supervisor to research and determine status of medical claims to assure billed dollars, claims aging, and pend values are consistent with contract provisions.

Designed training modules that implemented strategic business practices and organizational behavior training concepts. Planned and led training programs on staff development. Analyzed each line of business needs and developed new training programs based on the analysis. Effectively trained new and existing staff, supervisors, managers and directors on appropriate business and compliance practices, Medicare regulations, and department standards. Created effective training course objectives, course content and all materials. Led trainings for up to 40 employees at one time.

Maintain perfect attendance in order to fully support Supervisors and management. Support the team with questions and concerns. Process invoices to maintain personal knowledge and skills to support. Developed and maintained effective work instructions and plans and procedures. Conducted training for associates-either new hires or for process changes. Run reports applicable to the tasks at hand. Assist the associates in achieving their Standards of Performance. Data invoice reconciliation in order to make rapid and informed decisions.

Assist with providing accurate and appropriate information in response to customer inquiries in regards to their medical insurance plan. Demonstrated mastery of customer service etiquette within specified time frames. Maintained exceptional call handling time and standards of Performance (SOP). Made reasonable procedure exceptions to accommodate unusual customer requests. Maintained up-to-date records at all times. Assisted Providers with Claims Inquires and Eligibility. Conducted training for associates to stay up to date on our current procedures for Cal Mediconnect and SHP.