• Conduct detailed reviews and audits in consistent manner.• Analyze quality assurance data and share results with appropriate people.• Prepare quality improvement reports to committees and colleagues.• Provide feedback to individual personnel as appropriate in manner which supports efforts to achieve improvement goals.

I help process benefits for new hires, rehires and handle questions about benefits and the open enrollment period.

Contact assigned list of Veterans to determine their medical appointment scheduling preference Provider and availabilityContact In- Network providers to schedule appointment within Veteran Preference and contracted time framesTrack all booked and arrived appointments for patients generated through outreach effortsEnsure patient confidentiality with the handling of all patient health information and records

Ensures the accurate, prompt and thorough evaluation of claims by analyzing and determining the appropriate action steps neededwhile adhering to both internal and external regulations and ensuring an industry leading customer experience.Requires independent decision making on complex claims situations using critical thinking. Claims analysis includes: eligibilitydetermination for benefits based on medical information received, contract analysis, customer service, fraud detection… Show more Ensures the accurate, prompt and thorough evaluation of claims by analyzing and determining the appropriate action steps neededwhile adhering to both internal and external regulations and ensuring an industry leading customer experience.Requires independent decision making on complex claims situations using critical thinking. Claims analysis includes: eligibilitydetermination for benefits based on medical information received, contract analysis, customer service, fraud detection andawareness, financial calculations, interpreting information and adhering to all statutory / governmental regulations. This includesanalyzing information received, and determining if additional information is required to make an accurate benefits decision.Embraces the customer-focused strategy and demonstrates our shared values (Customer Focus, Integrity, Innovation,Accountability, and Collaboration) by providing effective customer service resulting in first request resolution and a positive customerexperience.Interacts, responds and resolves customer claim requests via multiple channels including phone, email and written correspondence.Performs multiple work roles with expanded knowledge and skill sets such as data entry, processing multifaceted transactions andhandling customer requests under minimal supervision Show less

I ensured the accuracy and completeness of submitted claims.Maintained a caseload average of 130 claims, consistently above the company goal of 85. Escalated claim red flags and concerns to management for additional monitoring.Reviewed and studied received medical records and work status updates to determine continuing or terminating benefits. Obtained necessary claim information by communicating verbally and in written form while maintaining a professional demeanor in all… Show more I ensured the accuracy and completeness of submitted claims.Maintained a caseload average of 130 claims, consistently above the company goal of 85. Escalated claim red flags and concerns to management for additional monitoring.Reviewed and studied received medical records and work status updates to determine continuing or terminating benefits. Obtained necessary claim information by communicating verbally and in written form while maintaining a professional demeanor in all interactions.Prepared and analyzed new claims for payment or denial in accordance with established procedures and guidelines, in a timely manner and meeting departmental quality and production standards.Manged telephone calls to and from claimants and employers to obtain necessary information vital to determining acceptance status. Show less

Received physician requests from transferring facilities and coordinated patient transfer to receiving facility for patients in need of a more specialized medical facility. Initiated and facilitated communication between referring and receiving physicians and coordinating hospital staff.Established positive working relationships with destination and transfer facilities to ensure various facility protocol is observed.

Informed delinquent account holders about overdue loan and credit card balances through outbound telephone contact.Processed payments and update inaccurate profile data.Negotiated with delinquent account holders about payment arrangements.

Troubleshooted orders with incoming callers.Instructed users on navigation of the ordering website.Helped customer place online orders and status of already placed orders.

Processed incoming orders by phone and electronic submissions.Entered new order requests into the system that were revived via mail.Processed payments of new orders and cancellations of existing orders.

Processed incoming payday loan applications by calculating available advance creditAccepted and administered MoneyGram Money Orders to customers.Distributed check cashing payments and per-paid card purchases .Handled collection calls to delinquent customers regarding past due payday loans.

Fielded inquiries regarding insurance and prescription health benefits.Supervised and monitored outstanding tasks for teammates and absent employees.

Utilize probing questions to troubleshoot cellular technical issuesEnsure one call resolution through providing accurate information, appropriate solutions, and completion of a call without transfer