Amber Fuller

• Created and processed disability claims across multiple channels
• Handled high call volumes and responded to inquiries with clarity and professionalism
• Maintained compliance with corporate policies and performance guarantees.
• Streamlined intake processes, enhancing efficiency in client data collection and management.
• Coordinated communication between clients and agents to facilitate the intake process efficiently.

• Create and uphold comprehensive records of provider demographics and data that influence all claims payments, provider directories, and communications with providers.
• Guarantee that all requests for provider updates (including additions, modifications, and deletions) are thoroughly researched, analyzed, addressed, and executed with precision and promptness.
• Confirm the credentials of all medical providers in accordance with the standards set by Blue Cross Blue Shield.
• Manage provider information for case processing and directory purposes by applying business rules.

• Engaged with members to provide information and education regarding medical management programs.

• Conducted research, executed data entry, addressed member inquiries, and assisted clinicians in the Medical Management department with their interactions involving providers and members.

• Responded promptly and accurately to communications received via telephone, fax, or voicemail.

• Gathered non-clinical data and collected structured clinical data for preauthorization purposes.

• Verified the eligibility of healthcare service benefits, selecting benefit levels in accordance with contractual guidelines and ensuring HIPAA compliance.

• Formulated and revised policies and procedures to ensure adherence to statutory, regulatory, and local, state, and federal guidelines related to HIPAA, benefits administration, and general liability.

• Facilitated the Risk Assessment Program by efficiently managing and responding to telephone calls, faxes, or voice mail messages in a timely and precise manner.

• Oversaw and evaluated behavioral health services.

• Gathered non-clinical data and structured clinical data for preauthorization purposes.

• Verified eligibility for Health Care Services Benefits by selecting benefit levels in accordance with contract guidelines and conducting HIPAA verifications.

• Managed referral requests, predeterminations, and the benefits process, providing training to others as necessary.

• Identified suitable treatment resources and made recommendations for patients to access these services.

• Provided counseling and support to clients dealing with substance abuse issues related to drugs and alcohol.

• Coordinated referrals for addiction services tailored to the specific needs and preferences of individual clients.

• Provided exceptional support to Medicare beneficiaries, guiding them through coverage options and plan details.
• Managed a high volume of inbound calls, adeptly navigating multiple systems while maintaining focus on customer needs.
• Educated customers on preventative care measures, promoting overall health and wellness among beneficiaries.
• Supported department goals by consistently meeting or exceeding established metrics related to call quality, timeliness, and accuracy.
• Established trust among customers by demonstrating empathy during challenging situations, providing reassurance, and offering expert guidance on available resources.