Cindy Smith Email & Phone Number

Remote

I have created an efficient grievance system to assist the Provider Relations Department to resolve disputes in a timely manner and have improved our provider retention by 30% in 3 months. I have assisted in mentoring three new employees as part of peer-to-peer mentoring program to improve efficiency of onboarding process. Maintained a 98% satisfaction rating over a 12-month period. ⦁ Instruct members on amounts covered in benefit plan in easy-to-understand terminology, and verify… Show more I have created an efficient grievance system to assist the Provider Relations Department to resolve disputes in a timely manner and have improved our provider retention by 30% in 3 months. I have assisted in mentoring three new employees as part of peer-to-peer mentoring program to improve efficiency of onboarding process. Maintained a 98% satisfaction rating over a 12-month period. ⦁ Instruct members on amounts covered in benefit plan in easy-to-understand terminology, and verify members have the proper insurance coverage prior to any appointment scheduling⦁ Provide non-judgmental confidental support, in crisis calls for those in emotional distress, by providing clinical resources, and escalating calls to on-site clinicians, in a calm, soothing manner in order to ease apprehension, and mental strain.⦁ Address member and provider inquiries, questions and concerns in all areas including enrollment, claims, benefit interpretation, and referrals/authorizations for medical care.⦁ Cross-Trained within 6 months of employment to manage behavioral health benefits, in partnership with Blue Cross Blue Shield, for Florida, and Michigan members and providers. Show less

Shelton, Connecticut, United States

Independently conducted thorough investigations of member correspondence, by analyzing claim denials, and obtaining reponses and information from internal entities. Accustomed to handling sensitive, confidential records. Demonstrated history of producing accurate, timely reports meeting stringent guidelines. ⦁ Managed the appeals process for all products and services, including reviewing documentation to determine if an appeal is warranted. ⦁ Prepared written determination letters… Show more Independently conducted thorough investigations of member correspondence, by analyzing claim denials, and obtaining reponses and information from internal entities. Accustomed to handling sensitive, confidential records. Demonstrated history of producing accurate, timely reports meeting stringent guidelines. ⦁ Managed the appeals process for all products and services, including reviewing documentation to determine if an appeal is warranted. ⦁ Prepared written determination letters that address the issue, and met all regulatory requirements within the required timeframe. ⦁ Responded to client concerns and complaints; informs clients of their appeal rights and the appeals process.⦁ Requested and obtained enrollment history, claims history and/or invoices as appropriate to assist with research. Show less

Demonstrated organizational skills by cross-training and providing backup for other customer service representatives when needed. Delivered an exceptional customer service experience, resolved issues and shared benefits of additional services. Recognized for being positive, intuitive, and client-centric.⦁ Responsible for researching, follow-ups, and resolution of customer accounts.⦁ Promoted additional products and services by upselling benefits/new features to… Show more Demonstrated organizational skills by cross-training and providing backup for other customer service representatives when needed. Delivered an exceptional customer service experience, resolved issues and shared benefits of additional services. Recognized for being positive, intuitive, and client-centric.⦁ Responsible for researching, follow-ups, and resolution of customer accounts.⦁ Promoted additional products and services by upselling benefits/new features to customers.⦁ Investigated general inquiries to maximize customer experience with products and services.⦁ Managed high volume inbound/outbound customer calls to troubleshoot technical issues and provide the first-call resolution.⦁ Assisted the workforce team with tracking customer call volume to determine the level of call activity on a daily basis.⦁ Responsible for researching, follow-ups, and resolution of customer accounts. Show less

3.0, Liberal Arts And Sciences, General Studies And Humanities

High School, General Studies, 3.2