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-Managed Utilization Review Nurses' work queues.-Sent clinical record requests to acute care facilities using HSR.-Reviewed faxes in Captiva and ingested clinical documentation to ECAA, the clinical database.-Placed a high volume of customer service calls to Primary Care offices to inform them of inpatient admissions.-Received and responded rapidly to inquiries from other clinical coordinators.-Utilized SOPs and various programs like ECAA and ICUE/HSR to locate and notate the correct case and ingest clinical records for utilization review.-Monitored clinical work queues and assigned work to other clinical coordinators.-Reviewed difficult cases that have been pended for additional review.100% remote position

-Reviewed and adjusted thousands of medical, dental, and vision claims of varying complexity with an unrelenting focus on speed and quality.-Consistently exceeded quality and VPH metrics since start of employment: Over 110% VPH and no quality errors.-Utilized Standard Operating Procedures (SOPs), Excel spreadsheets, and various programs (UNET, ICUE, Macro Express) to ensure complete and accurate adjustment of claims.-Effectively communicated with SMEs by phone, SME Sharepoint, Microsoft Outlook, or Webex to resolve complex claim issues.-Prepared and presented demos to a team of adjusters to foster an increase in team quality.-100% remote position