Sheila Decker Email & Phone Number

Lansing, Mi, Us

Amherst, New York, United States

I was a part of the member Experience Advocate team, providing strategic guidance in the nuanced de-escalation of high-profile health insurance claim appeals for both Meta and Meritain clients.Accomplishments:*Successfully resolved hundreds of META member claim escalations via the salesforce platform.*Resolved standard plan design, certification of coverage, and potential contractual deviations to determine the accuracy and appropriateness of a benefit/administrative… Show more I was a part of the member Experience Advocate team, providing strategic guidance in the nuanced de-escalation of high-profile health insurance claim appeals for both Meta and Meritain clients.Accomplishments:*Successfully resolved hundreds of META member claim escalations via the salesforce platform.*Resolved standard plan design, certification of coverage, and potential contractual deviations to determine the accuracy and appropriateness of a benefit/administrative denial.*Coordinated efforts internally and across departments to successfully resolve claim concerns and facilitate meetings with all levels across the organization via Microsoft Teams.*Created timelines, and presented cases via written documentation and verbal discussions in a group setting. *Assisted the benefit verification review team with retro pre-certifications.*Identified trends and process improvement opportunities and provided viable solutions. Show less

I played a pivotal role in handling inquiries related to fully insured and short-term medical insurance policies. I adeptly resolved client and provider escalations, addressed claim appeals, and meticulously finalized senior policy adjustments through data general coding.Accomplishments:*Provided claim status and benefits verification for fully insured/short-term medical plans using plan documents, production data general, and CSI. *Verifying precertification and… Show more I played a pivotal role in handling inquiries related to fully insured and short-term medical insurance policies. I adeptly resolved client and provider escalations, addressed claim appeals, and meticulously finalized senior policy adjustments through data general coding.Accomplishments:*Provided claim status and benefits verification for fully insured/short-term medical plans using plan documents, production data general, and CSI. *Verifying precertification and predetermination requirements per plan policy guidelines.*Processes claim referrals, new claim handoffs, reviews complaints (member/provider), and appeals via the target system.*Provided Data integrity by correctly entering data and reporting any identified discrepancies. *Initiated pre-certifications and predeterminations per plan policy guidelines. Show less

Lansing, Michigan, United States

I spearheaded the management of the company's distinguished customer response team, navigating and resolving service tickets using our internal move software. Additionally, I assumed a leadership role in overseeing the company's online chat service via the Two Men & a Truck website to promote sales.Accomplishments*I worked with employees to improve performance, provided ongoing feedback, and developed innovative plans with employees to identify career development opportunities… Show more I spearheaded the management of the company's distinguished customer response team, navigating and resolving service tickets using our internal move software. Additionally, I assumed a leadership role in overseeing the company's online chat service via the Two Men & a Truck website to promote sales.Accomplishments*I worked with employees to improve performance, provided ongoing feedback, and developed innovative plans with employees to identify career development opportunities. *Quality assurance and call audits for all team members including improvement plans and training.*I followed up with customers post-move to ensure satisfaction.*Calmly and professionally handled customer concerns, complaints, or customer service issues.*Trained and managed the daily workload to ensure required service volume and quality levels were attained.*Coordinated team meetings and events, including strategic partnerships and marketing initiatives. Show less