Assisting performance auditing department in meeting report deadlines• Utilizing analytical skills to conduct random reviews for Managed Care Administration claims department• Maintain regular communication with leadership and peers for an effective work flow• Conducted daily review of division of financial responsibility, health plan websites, code correct• Computing financial outcomes for medical claims• Review patient chart notes for claim outcome• Assure claims are… Show more Assisting performance auditing department in meeting report deadlines• Utilizing analytical skills to conduct random reviews for Managed Care Administration claims department• Maintain regular communication with leadership and peers for an effective work flow• Conducted daily review of division of financial responsibility, health plan websites, code correct• Computing financial outcomes for medical claims• Review patient chart notes for claim outcome• Assure claims are paid properly under case rate amount• Review vendor contracts daily Show less

Input claims on a daily basis• Process eligibility verification, new day claim processing, and EOB retrievalResearch and follows up on unpaid claims, denials, tracers and demand claims• Audit accounts to determine accuracy of charges and adjustments• Responsible for resolving claim issues• Maintain records of communications and work files

Provided high level customer service via phone• Strong analytical and problem solving skills• Effective communication skills• Possessed exemplary customer service soft skills.

2 yrs; Listened to representatives calls and provided them with creative feedback to help them provide bettercustomer service• Created spreadsheets and graphs in excel• Coached representatives with opportunities to provide better customer service• Maintained motivation, identifying personal strengths and opportunities and working with supervisor todevelop career enhancing skills.

Responds to routine inquires involving multiple products relating to eligibility, pharmacy, claims, and providerrequest.• Contacted physicians groups, and IPA's• Handled difficult phones inquires from irate or emotionally upset members• Helped providers with information to bill their claims accurately and timely for payment