Jacquelyn Cather Email & Phone Number

Hamilton, New Jersey

Cranbury, New Jersey

Coordinated responses from multiple business units and executives to resolve pre- and post-service complaints and appeals pertaining to traditional and managed care. Ensured compliance with state and federal guidelines, Department of Insurance, Department of Health, and the Attorney General’s office on behalf of providers and physicians. Worked closely with benefit administrators, utilizing knowledge of trends, emerging issues, and health plans to recommend solutions.Selected Contributions:• Averaged 65 case reviews per week, maintaining over an average quality rating of 99.4%.• Secured over $2M per year, reviewing and deciding $500 to $1K individual cases and $1K+ hospital inquiries. • Saved thousands of dollars for the company and the insured through special investigations of insurance fraud and unreasonable out-of-network provider billing claims.• Guided transition during the Prudential merger, training new hires and Appeals Analysts on claims processing and managing extra workflow of acquired groups.

Cranbury, New Jersey

Managed predetermination of benefits based on specific plan benefits. Mentored Claim Benefit Specialists in determining benefits for pre-adjudicated claims.Educated team members on policy and processing guidelines. Conducted reviews and audits for compliance with policy guidelines.

Millville, New Jersey And Cranbury, New Jersey

Responsible for reviewing and processing group health claims based on specific plan benefits.