Responsible for providing exceptional customer service to internal and external customers who have concerns about the benefit structure of various prescription drug insurance plans. Included reviewing pharmacy claims for accuracy and appropriate processing procedures. Recognized by call center management, after being on the job for only two weeks, for exceptional interaction with internal constituents. Selected as a peer group mentor and responsible for providing education and guidance to colleagues who had questions and concerns regarding the company’s Opioid Utilization Program and it’s Grievance and Appeals process. Selected to assist with the training of newly hired employees assigned to both the Commercial and Medicare platforms of the company’s business.

Worked with insurance providers, government agencies, and educational institutions to place new product, repair or rental orders for speech generating devices... utilized on-line resources and maintained frequent communication with funding agencies to verify eligibility...reviewed prior authorization documents against third party payer criteria...served as a client advocate by communicating with clients and family members on funding requests and co-payment requirements, representing client's case with third party insurance providers and trouble-shooting any problems to resolution...resolved third party denials.

Responsible for providing marketing and technical support to subscribers of an identity protection program...included providing support and interfacing with the various institutions involved with investigating reports of fraud

Responsible for following up on outstanding receivables due from all classes of payers including self-pay; includes resolution of denials. Responsible for handling all correspondence related to an insurance matter or patient's account, contacting insurance carriers, patients, and other facilities as needed to get maximum payment on accounts; identify issues or changes necessary to achieve profitability. Researched and resolved accounts appearing on delinquent insurance reports, collection ledgers, and government payer reports.

Responsible for coordinating the delivery of durable medical supplies, on a recurring basis, to established customers and individuals referred by various medical providers. Included verifying the existence of required medical coverage and benefit structure, contact with medical providers to confirm that the proper diagnostic requirements have been met, and contact with the patient/policyholder to arrange delivery of supplies. Required a complete understanding of medical diagnostic and procedure coding; also required a comprehensive knowledge of the products offered by the company and its competitors

Initially hired to resolve enrollment and eligibility issues related to the purchase of Medicare-replacement insurance products. Created the procedures used in all of the company's Medicare call centers pertaining to the submission of outbound correspondence; selected, trained, and supervised the (6) employees responsible for quality audits of all outbound correspondence. Cross-trained in medical claims processing and acted as a liaison between the customer service and claims departments in the resolution of escalated issues.

Working within an assigned disease state and with assigned insurance carriers, responsible for verifying the existence of applicable insurance coverage and satisfaction of pre-certification issues related to specialty medication orders. Included contact with medical providers, freight carrier representatives, and patient/policyholder to address related issues.

Responsible for marketing Medicare-replacement insurance products; target and qualify prospects. Required thorough knowledge of Medicare regulations and standards. Recognized as a "Selling Star" for exceeding sales goals

Responsible for establishing payroll-deduct insurance accounts and expanding product lines to existing customers base; target and qualify new prospects. Highly skilled in relationship selling, networking, and cold canvassing. Recognized for offering assistance to co-workers in advancing organizational goals and objectives. Consistently exceeded sales objectives and was honored twice nationally for exceeding sales goals.

Managed an active monthly caseload of 600 or more personal injury claims focusing on their possible subrogation potential; files had a recovery value of $2.8 to $3.5 million dollars. Negotiated the reimbursement of paid medical claims from the proceeds of insurance claim settlements. Determined covered losses by having an excellent understanding of group health insurance policy provisions, a thorough knowledge of medical terminology and diagnostic/treatment coding. Obtained Property and Casualty Examiner certification in Pennsylvania and Kentucky. Honored as "Examiner of the Month" on four occasions. Member of "CEO's Club" honoring examiners with recoveries in excess of one million dollars in a given year.