Audited, investigated, and negotiated insurance claims while managing $10M+ grievance/compliance process queue.▪ Streamlined business processes and recommended operational workflow improvements to increase efficiency.

Facilitated members with properly using medical and pharmacy benefits, eligibility, and claim resolution. Triaged dental and vision issues, assisted with plan selection and enrollment, and improved health care literacy.▪ Enhanced claims processing for more than 500+ patients, auditing claims and ensuring appropriate procedures to safeguard quality assurance.▪ Alleviated internal and external-facing conflicts by providing valuable client-focused services to support members with Clinical,… Show more Facilitated members with properly using medical and pharmacy benefits, eligibility, and claim resolution. Triaged dental and vision issues, assisted with plan selection and enrollment, and improved health care literacy.▪ Enhanced claims processing for more than 500+ patients, auditing claims and ensuring appropriate procedures to safeguard quality assurance.▪ Alleviated internal and external-facing conflicts by providing valuable client-focused services to support members with Clinical, Financial Decision Support, Behavioral Support, and Claims inquiries. ▪ Managed appointment scheduling, resolved billing concerns, and determined coverage qualifications for over 1,000+ providers. ▪ Advocated for over 50,000 members and third-party vendors with responsibility for ensuring members have access to local resources and healthcare; meditated between providers and members to ensure proper healthcare administration.▪ Leveraged knowledge of medical systems, websites, and tools to coach members on how to find resources, documents, and programs. Show less

Collaborated with Case Management, Financial Counselors, and members of the Revenue Cycle Division responsible for insurance verification on a variety of patient types, including outpatient, inpatient, and observation admissions. Identified opportunities to improve payer master file by leveraging expertise in insurance plans and contracts. ▪ Served as liaison with insurance carriers, health plan vendors, and client team members to resolve and address health insurance-related concerns… Show more Collaborated with Case Management, Financial Counselors, and members of the Revenue Cycle Division responsible for insurance verification on a variety of patient types, including outpatient, inpatient, and observation admissions. Identified opportunities to improve payer master file by leveraging expertise in insurance plans and contracts. ▪ Served as liaison with insurance carriers, health plan vendors, and client team members to resolve and address health insurance-related concerns, providing customer service, feedback, and support with Ordering DME supplies.▪ Verified patient’s insurance information, ensured active coverage, and obtained authorizations prior to scheduled visits in accordance with HIPAA guidelines and regulatory requirements. ▪ Audited operational reports and performed data entry to update customer information while proactively mitigating challenges and improving customer experience. ▪ Managed an average of 40+ claims and maintained responsibility for verifying payments on claims, resubmitting claims, and ensuring proper handling of denied claims. Show less

Established new accounts and determined / met specific client needs to execute a solid knowledge of TD Bank’s products and services. Implemented streamlined measures to improve servicing, growing, and retaining the branch client portfolio. ▪ Promoted Business Banking, Wealth Management, Treasury Management, and Merchant Services by collaborating across over 100 internal and external departments to implement new partnerships and promotions. ▪ Incorporated best practices in overseeing… Show more Established new accounts and determined / met specific client needs to execute a solid knowledge of TD Bank’s products and services. Implemented streamlined measures to improve servicing, growing, and retaining the branch client portfolio. ▪ Promoted Business Banking, Wealth Management, Treasury Management, and Merchant Services by collaborating across over 100 internal and external departments to implement new partnerships and promotions. ▪ Incorporated best practices in overseeing sales, credit analysis, monitoring, proper loan structuring, client interviews, and perceptive character judgment. ▪ Analyzed loan applications for approval and/or denial with lending authority and input loan applications for the Branch Manager to review before submission. Show less

Reviewed reports and conducted investigative research. Played an integral role in performing root cause analysis to provide solutions for customer issues while documenting all actions for assigned cases. ▪ Maintained responsibility for communicating with and educating customers via telephone, e-mail, or regular mail in a call center environment. ▪ Served as a liaison between internal departments and stakeholders, including Store Managers and Regional Managers, to ensure the timely… Show more Reviewed reports and conducted investigative research. Played an integral role in performing root cause analysis to provide solutions for customer issues while documenting all actions for assigned cases. ▪ Maintained responsibility for communicating with and educating customers via telephone, e-mail, or regular mail in a call center environment. ▪ Served as a liaison between internal departments and stakeholders, including Store Managers and Regional Managers, to ensure the timely resolution of customer-related issues. Show less

Responsible for all business, financial, and administrative support for Associated Cabs Inc. Managed vendor relationships, contract negotiations, and client relationships management (CRM) while identifying opportunities that drive profit margin and mitigate risk. Dispatched and oversaw a fleet of 200+ taxis via computer and GPS tracking.▪ Managed high volume of customer inquiries, providing professional customer-focused interaction by phone, email, or in person; resolved escalated support… Show more Responsible for all business, financial, and administrative support for Associated Cabs Inc. Managed vendor relationships, contract negotiations, and client relationships management (CRM) while identifying opportunities that drive profit margin and mitigate risk. Dispatched and oversaw a fleet of 200+ taxis via computer and GPS tracking.▪ Managed high volume of customer inquiries, providing professional customer-focused interaction by phone, email, or in person; resolved escalated support issues through root cause analysis and pattern recognition to identify repetitive problems. ▪ Facilitated organizational alignment for priorities and results and ensured high levels of customer satisfaction by establishing and maintaining strong interdepartmental relationships. ▪ Managed various administrative Account Management functions, including billing, logistics coordination, and problem resolution. ▪ Audited more than 500+ accounts and payments to ensure compliance with financial policies and procedures.▪ Directed client invoicing with responsibility for resolving any invoice-related problems and concerns. Show less

Responded to inquiries from members and providers calling in to Behavioral Health department. Provided members with coaching and consulting on various health plans, policies, and advantages.▪ Clarified benefits for members’ mental health and substance abuse treatment and provided clients with referrals.▪ Enforced HIPPA laws with providers and members to ensure safety of members.▪ Entered patient Admissions and Outpatient authorizations into the company system, ensuring accuracy.