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• Worked in partnership with audit process SMEs and leaders to resolve escalated issues and process guideline updates

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• Identified reasons for variations in performance and developed action plans to ensure goal expectations were met

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)