Claims Adjustment Rep.
United Health Group
- To review and research claims by navigating multiple computer systems and platforms and accurately capturing the data/information necessary for processing
- To complete necessary adjustments to claims and ensures the proper benefits are applied to each claim by using the appropriate processes and procedures
- To complete on a daily basis all data entry required to document and communicate the status of claims as needed adhering to all reporting requirements
- To review medicaid related claims and to execute them according to their corresponding benefit plan and contractual amount
- To review medical records and provider agreements in accordance to corresponding denial or approvals
April 2016October 2016
Behavioral Health Advocate I
Blue Cross Blue Shield
- To maintain communication with management regarding developments within areas of assigned responsibilities and perform special projects as required or requested.
- To maintain liaison with in-house areas regarding groups’ concerns, e.g. Marketing, Provider Affairs, and SSD.
- To route cases appropriately pursuant to the workflow for clinical review or to other departments as necessary.
- To collect clinical data using appropriate clinical data screens and enter information into the system.
- To process or pend for clinical review certifications/authorization requests according to established policies and procedures from the work queue. To select contract eligibility, as it relates to precertification and/or referral authorization requests based upon information provided by hospital personnel, members, and providers.
- To review/respond to service requests from incoming calls, faxes/Images, recorded voicemail messages from hospitals, providers, and members. Inquiries include referral request current and retro from PCP to specialist, and authorization requests for in and outpatient treatment. Assist members including explaining the different types of behavioral health providers and the services they provide.
August 2015April 2016
Mutual Funds Associate (Contract)
- To process and execute transactions according to market based trends. To ensure remarkable customer service is given while preserving account integrity.
- To process and review transactions for accuracy based on market trends and compliance guidelines.
- To maintain all account maintenance on mutual fund accounts according to company policy and market guidelines.
- To maintain product knowledge of current market trends in order to ensure transaction compliance.
Octoober 2014February 2015
Customer Service Supervisor(Seasonal)
Burlington Coat Factory
- To plan and coordinate multiple tasks throughout the day to ensure all associates are at maximum productivity.
- To ensure that each associate is adhering to scheduled breaks and lunches accordingly.
- To supervise each associate and to ensure that all tasks are completed by each associate by the end of work day.
- To Prepare the daily schedule for each associate according to policies and procedures.
- To ensure that each customer service associate is delivering an exceptional customer service experience.
- To ensure that all metrics and customer service surveys are being met on a individual basis and store wide basis.
- To Communicate with other departments and management to resolve problems and expedite work.
- To Resolve complaints and answer questions of customers regarding services and procedures.