Review and process Medical & dental claims in a timely manner for numerous site locations. Review Pre Cert Authorizations and denials for each claim.

Reviewed and processed Medical & RX claims to COB with secondary payor networks such as BCBS & United Health Care in a timely manner with efficiency.Handled daily inbound calls from members and providers to assist in understanding their plan benefits to assisiting with claims details.Worked with account managers of various group plans to assist members with RX & claim needs that needed to be expedited.

Add new providers & various PPO networks into the data base for claims to receive the correct PPO discount. Price & apply discounts to the claims. Verify eligibility on patients. Process inmate claims for an outside company. Load & configure RX claims. Take customer service calls for flexible spending account holders. Train & audit new employees.