Alexis Johnson

• Supervise multiple teams of examiners and technical operations colleagues, delegating duties and ensuring compliance with policies and regulations.

• Oversee claim adjudication, quality reviews, and reserve approvals for high-cost and complex claims.

• Act as the second level of appeal for client and claimant disputes, determining final resolutions.

• Monitor third-party claims, litigated cases, and sensitive vocational rehabilitation matters.

• Maintain strong client relationships by providing claim recommendations, updates, and detailed reports.

• Manage team performance, including hiring, training, and coaching to drive efficiency and quality.

• Maintained knowledge of applicable laws, regulations, policies, procedures, etc., pertaining to assigned duties/responsibilities
• Responded to attorney inquiries and litigation notices
• Created, composed and maintained appeal response templates
• Coordinated with senior specialist to compose appeal responses
• Maintained confidentiality of patient finances, records, and health statuses
• Collaborate with Independent Physician Advisors to analyze claims

• Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations
• Used administrative guidelines as resource or to answer questions when processing medical claims

• Managed 350-400 claims per day
• Improved office efficiency by effectively managing internal communications and correspondence
• Implemented process improvements to automate office operations, including updating claim handling process as needed and updating claim correspondences
• Partnered with client to ascertain staffing needs and subsequently provide communicate between client and claimant
• Administered benefits programs, analyzed compensation and PTO
• Educated staff and claimants on local, State and Federal job protection with special emphasis in FMLA, Short Term Disability, and time tracking
• Collected and analyzed information to monitor compliance with State and Federal laws outcome
• Identify and address trends of non-compliant behavior
• Assisted senior management with making key decisions by developing and submitting time cards and compensation reports with claim status updates

• Learned and maintained in-depth understanding of product and service information to offer knowledgeable and educated responses to diverse customer questions
• Resolved customer service issues using company processes and policies and provided updates to customers
• Researched and rapidly resolved client conflicts to maintain key accounts
• Coached new team members on service techniques and provided scoring through quality assurance program
• Escalated issues to proper supervisors when standard processes were not effective
• Checked status of orders and back-ordered products to coordinate efficient shipments
• Trained and directed new employees in call script use, conflict resolution and data entry practices to boost customer satisfaction ratings