Aleea Dale

• Enhanced customer satisfaction by promptly addressing inquiries and resolving issues.
• Collaborated with team members to develop strategies for continuous improvement in service delivery.
• Built strong relationships with clients, fostering trust and loyalty through personalized assistance.
• Exceeded performance metrics consistently by delivering exceptional customer service experiences.
• Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
• Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
• Developed strong product knowledge to provide informed recommendations based on individual customer needs.

• Managed the complete reimbursement cycle for over 450 claims per month as a team, ensuring timely and accurate payment processing for Medicare, Medicaid, and private insurance.

• Reviewed and analyzed complex claims to ensure compliance with insurance regulations and payer requirements, leading to a reduction in claim denials.

• Coordinated with insurance companies to resolve reimbursement discrepancies and worked closely with providers to ensure payment accuracy and compliance.

• Led appeals processes for denied claims, resulting in approval rate on contested claims.

• Coordinated high volume calls per day, efficiently dispatching vehicles for deliveries, service requests, or emergency responses.

• Monitored real-time location of vehicles through GPS and adjusted routes to ensure timely delivery and optimal fuel usage.

• Provided clear, accurate instructions to drivers, emergency responders, and clients to ensure safety and success during operations.

• Managed incoming service requests and coordinated with dispatch teams to ensure seamless operations.

• Kept meticulous logs of all calls, dispatches, and incident reports, ensuring compliance with internal procedures and industry regulations.

• Responded to customer inquiries and complaints, offering resolutions in a calm, efficient, and professional manner.

• Decision-Making & Case Evaluation: Made critical claims decisions in partnership with management by thoroughly evaluating claim facts, policy provisions, and special handling agreements, ensuring decisions aligned with company procedures and standards.

• Case File Management: Developed and maintained comprehensive case files, meticulously documenting all claim decisions and actions. Regularly updated files with claim facts, medical/vocational data, and financial assessments, ensuring thorough and accurate documentation at every step of the process.

• Cross-Department Collaboration: Collaborated with brokers, sales teams, legal, underwriting, and other internal departments to facilitate smooth claim resolution and foster strong relationships.

• Stakeholder Communication: Managed high-volume communication with claimants, medical professionals, employers, and other stakeholders to gather relevant claim information, address inquiries, and keep parties informed throughout the claims lifecycle.

• Financial Liability Assessment: Assessed claimants’ financial liability by analyzing salary, benefits, and contract language, ensuring accurate payment approvals based on detailed evaluations of claims.

• Holistic Claims Review: Evaluated ongoing claim liabilities, identified changes in claim status, and worked with external partners such as physicians, vocational experts, and financial resources to adjust claims and payments accordingly.