Linda Edmonds Email & Phone Number

United States

Trained new hire representatives within the Escalation unit on methodologies and company operations.Aiding and mentoring new hires and other call center representatives, assisting with questions, and providing feedback on processes and best practices.Answering direct questions and offering immediate help to all call center representatives by phone, email, instant messenger, and face to face contacts.Acting as an immediate resource by taking over and resolving escalated calls involving eligibility, benefits, claims, coordination of benefits, and other medical insurance concerns.Controlling complex member contacts involving the filing of grievances and complaints. Providing follow-up and documenting details of those contacts for the States Department of Social Service’s records.Actively communicating with the States Department of Social Services enrollment Escalation team concerning urgent insurance eligibility issues and other member resolutions.Partnering with the Connecticut Department of Children and Family Services to address insurance eligibility, claims, service providers, supplies, and equipment for at-risk families.Confirm that the client’s insurance coverage and Third-Party Liability information is listed correctly. That is achieved by conducting research and partnering with the Coordination of Benefits department.Working with the Compliance Department to ensure correct documentation has been received from the customer for authorized representation and the release of protected health information.Aiding in new system testing and providing feedback regarding enhancements or improvements for optimal utilization.Maintain knowledge of Connecticut Medicaid and Federal Medicare policies and procedures for Provider Services and Member Services.

Fairfield County, Connecticut, United States

Ensuring that the quality and productivity goals are met by the staff. Providing coaching, feedback, and assistance with complex escalated calls and claim issues.Make recommendations for training programs. Assist in developing and implementing service improvement initiatives to include Medicaid and Medicare liaison for Knowledge Base, CSI enhancements, Medicare pricing system, and MARX system.Serves as a liaison between the management staff and the other team members for resolving service issues and providing appropriate resources and tools to team members.A Member of the Continuous Process Improvement Committee. Within this committee, I actively provided feedback, developed action plans to improve workflows, and participated in training and the rollout of new processes.Conducted quality monitoring and feedback to the team members regarding call quality and productivity.Facilitated bi-weekly training sessions to ensure the team is current on product knowledge, government policy changes, and system enhancement, as well as participating in new hire training.Filtered, researched, and resolved complex escalated client and provider calls. Investigated the concerns and provided resolution or updates within 48 hours.Processing new day Medicare and Medicaid medical claims as well as reprocessing medical claims that contained multiple errors.Being a resource line for team members with questions. Team members could call my direct line with any issues they may have with products, services, and billing concerns for the members and providers. If the team member could not handle the caller, it would then be transferred to my line for the member to be further assisted.Assisted with Manager level customer escalations and other demanding issues face to face and on our resource line. Working directly with the Medicare Program to ensure accurate eligibility information is listed in the MARX system and the Firm Ells system.

Bachelor Of Business Administration - Bba, Business Administration And Management, General, Graduate

General Studies, General Studies