Facilitates positive and productive interactions between workers, leaders and union representatives. Successful background reaching consensus and smoothing relations to maximize success of negotiations. Articulate and decisive professional with respectful and resourceful approach. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Skills
Creative Solutions
Customer Service Process Improvement
Investigative Writing
Preparation of Appeals
Appeals Support
Civil Litigation
Drug Formularies
Case Research
Grievance Resolution
Grievance Arbitration
Client Relationships
Community Resources
Medicare Compliance
Basic Medical Terminology
Education
Lancaster Bible CollegeLancaster, PAExpected in 09/2021 – –Associate of Arts:Human Resources Management - GPA:
Cheyney UniversityCheyney, PA, Expected in 06/2007 – –Associate of Science:Criminal Justice - GPA:
Continuing education in Human Resource
Minored in Psychology
John Bartram High SchoolPhiladelphia, PAExpected in 06/2002 – –High School Diploma: - GPA:
Work History
Bone And Joint Center, S.C. - Appeals Analyst Schofield, WI, 11/2017 - Current
Reviewed, analyzed and processed non-complex grievances and appeals.
Analyzed and rendered determinations on assigned non-complex grievance and appeal issues.
Conducted day-to-day administrative tasks to maintain information files and process paperwork.
Examined claims forms and other records to determine insurance coverage.
Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
Researched claims and incident information to deliver solutions and resolve problems.
Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
Analyzed information gathered by investigation and report findings and recommendations.
Collaborated with claims department and industry anti-fraud organizations to resolve claims.
Million Air - Lead Customer Service Representative Sanford, FL, 07/2013 - 06/2015
Planned schedules and workflows based on expected customer demands.
Trained, oversaw and mentored new team members to strengthen performance and job expertise.
Engaged clients in person and over phone to answer questions and address complaints.
Maintained accurate and current customer account data with manual forms processing and digital information updates.
Scanned, received and sent faxes to appropriate departments, including insurance claims, co-pay assistance information and patient documentation.
Performed needs analysis to obtain information required to make appropriate health insurance product recommendations.
Contacted insurance companies to discuss and resolve unpaid claims and incorrectly paid claims.
Approached potential clients by using direct marketing techniques, including mailings and phone contacts.
Worked to accommodate new and different insurance requests and explored new value opportunities to optimize insurance agency reputation.
Responded to customer calls within 3 hours to swiftly resolve issues and answer questions.
Charter Spectrum - Supervisor Evansville, IN, 09/2008 - 08/2012
Created efficient work schedules for each team member to maintain deadlines and keep shifts properly staffed.
Applied strong leadership talents and problem-solving skills to maintain team efficiency and organize workflows to meet any daily demand.
Developed training, task and process guidelines and communicated clear and concise directions to employees.
Conducted functional behavior assessments, functional analysis, preference assessments and assessments of basic learning and language skills to identify target behaviors and purpose of behaviors.
Worked closely with adults and children in various settings, including in community, at residential facilities and within homes.
Identified appropriate treatment resources and recommended patients for these services.
Created all documentation, including progress reports, assessments and charting within required timeframes.
Trained residential staff on symptoms management and intervention strategies for clients with various behavioral issues.
Developed written behavioral plans in Spanish for bilingual patients.
Delivered client assessments for those struggling with addiction or relationship issues and implemented strategies based on client needs.
Worked collaboratively with other mental health professionals to provide consistent care and minimize diversion.
Consulted with other staff members regarding treatment plans as deemed appropriate by team leader.
Taught clients how to complete basic household chores and prepare food.
Evaluated employee performance and coached and trained to improve weak areas.
Built and maintained positive staff relationships to promote teamwork and better serve clients.
Performed client intake procedures according to internal standards for all new admissions.
Searched resident belongings prior to and during stays.
Involved clients' family members in planning social service programs.
Enhanced group productivity 70% by developing and implementing new strategies
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