Dorna Griffiths Email & Phone Number

Bridgewater, New Jersey, United States

DRIVEN PROACTIVE QUALITY ASSURANCE PROFESSIONAL WITH EXCEPTIONAL EXPERIENCE IN CUSTOMER SERVICE, RETAIL AND HEALTH INSURANCE BUSINESSES. PROVEN SUCCESS IN TEAM-ORIENTED AND LEADERSHIP ROLES. CONSISTENTLY PROMOTED AND RECOGNIZED INDIVIDUAL WILLING TO TAKE ON NEW CHALLENGES.

Plainfield, NJ

Create sales and business records for the accountant Prepare contracts and proposals Customer servicePayroll

Newark, NJ

• Audited individual corporate accounts, vendor accounts determining performance levels and accuracy of processes
• Ensured compliance by examining steps taken by employees for each account
• Identified process failures, both system or manually generated
• Generated monthly reports providing audit analysis results, error trends and made recommendations for corrective action
• Oversaw reconciliation of claim over-payments, following up with impacted departments to ensure recapture of corporate
• Streamlined processes and procedures for every department through analysis of systemic and team workflows, identifying problems, and eliminating bottlenecks and redundancies

Newark, NJ

• Mentored and trained new hires, assuming responsibility for more technical and difficult roles in claims processing
• Prepared, coordinated claim policy inquires for review by the Medical Director
• Reviewed, calculated and priced high dollar Oncology and Specialty drugs for accuracy
• Served as main dedicated Account Rep for two Fortune 500 Companies -New Jersey Turnpike Authority and Public Service Electric & Gas (PSE&G)
• Responded to group’s questions regarding managed care services, developing client understanding of contracts
• Performed trend analysis and compiled weekly reports of team’s daily production, reporting and reviewing findings with team leaders

Newark, NJ

• Dedicated full service customer service representative responsible for the handling high profile customer’s telephone and written inquires, interfacing with both Human Resource Managers and Directors
• Processed claims, handling end to end, ensuring customer satisfaction
• Provided customer education regarding to the understanding and interpretation of their contracts
• Processed and handled exception claims for high profile corporate executives, coordinating appeals and taking to the next level for speedy and accurate resolution.
• Responded to questions from members and company officials regarding referral protocol and benefits in the managed care world