Doris Benson, Msm Email & Phone Number

Louisville, Kentucky, United States

• Lead collaboration in creating an intake SharePoint site for program owners to submit claim audit update requests worked by offshore staff reducing onshore volume by 50%
• Direct point of contact for the established Power BI dashboard reporting for weekly clinical inquiry volume and production and the intake SharePoint site
• Cooperatively manage a weekly average of 100 incoming clinical audit inquiries requiring expedited research and immediate resolution
• Use TOAD query data to conduct daily audit findings notifications for providers to review detailed claim review outcomes from our Clinical and Special Investigative departments

Louisville, Kentucky

• Managed a team of 130+ Sagility offshore associates to include monitoring staff and production
• Collaborated with various audit/programming teams to reduce company costs by coordinating the offshoring of Clinical Audit processes
• Directed communication with Global Outsourcing for Sagility contract updates and amendments for offshored processes
• Facilitated training and required process guidelines for Sagility associates to learn new processes
• Connected with our Quality Audit area to ensure production is meeting quality requirements
• Reviewed daily production data for processes to address any aging items

Louisville, Kentucky, United States

• Managed a team of 16 on-shore associates and 3 off-shore teams to resolve various overpayment check error issues
• Developed changes to simplify and streamline check payment error resolution
• Collaborated with other teams within the Financial Recovery environment to discover the source and answer for check error issues
• Supervised a specialized team that handled disputed overpayment issues from providers in the Claims Information Exchange system
• Managed the specialized team that researches and resolves complex overpayment issues through Emailed inquiries
• Developed relationships with associates by providing effective leadership skills and motivation to 16 full time employees

Louisville, Kentucky, United States

• Facilitated calls with key providers to discuss overpayment process improvements, contract discrepancies, and clinical issues
• Researched and resolve complex overpayment issues due to member enrollment, contract discrepancies, and billing errors
• Maintained relationship with high profile providers by engaging in conference calls and quarterly meetings to discuss issues
• Performed IT testing of overpayment software startup for the Claims Information Exchange system for audit inquiries

Louisville, Kentucky, United States

• Investigated potential health care fraud, waste & abuse allegations
• Compiled data from multiple resources to prepare findings and recommendations for accuracy of claim payments
• Analyzed medical records to verify services rendered and codes billed
• Facilitated meetings with management and market representatives to review case findings
• Educated providers and their staff regarding their billing practices and documentation

Louisville, Kentucky

• Utilized excellent communication skills to serve as a single point of contact for customers’ inquiries about their benefits plan
• Ensured that contact center associates have the tools, resources and information to service customers and resolve issues quickly
• Collaborated with Market Sales associates to ensure an exceptional customer experience and service for new and renewing customers
• Acted as a subject matter expert for customer support service agreements and associated support levels

Louisville, Kentucky

• Worked daily using Benefits, Pharmacy, Claims, and Group training with numerous systems such as CCP2, MTV and CAS to quickly resolve incoming inquiries from customers
• Achieved high company call quality performance rating averages and resolved over 250 weekly insurance and healthcare inquiries
• Effectively communicated medical claims and procedures while offering exceptional customer service to partners
• Used proven analytical, organizational, team building and listening skills in order to achieve company goals

Louisville, Kentucky, United States

• Evaluated the necessity of the medical treatment and discounted any excessive or unrelated treatment in my overall assessment of the injury claim
• Participated in approximately 1 to 2 mediations per month as an alternative to proceeding to a trial by jury with a majority success rate in settlements
• Handled litigation with appropriate defense attorney involvement with a 90% success rate in verdicts that were within my original claim file evaluations
• Developed and conducted insurance policy training seminars to agency staff members on customer service and initial claim handling procedures
• Received recognition from the subrogation department after preparing arbitration documentation that resulted in $25,000 reimbursement to State Farm Insurance

Msm, Management Science

Bs, Mathematics

Activities and Societies: Alpha Kappa Alpha Sorority, Inc., Jack & Jill of America, Inc., NBMBAA (MBA association)