Annessa Matthews
Murfreesboro,TN
Summary
Clinical Administrator ~ Resolution Specialist ~ Customer Service
Highly qualified and dependable Senior Customer Service Professional with 7+ years of experience in a call center environment. Industry experience includes Healthcare and IT Services. Professional skills include but are not limited to: Health Care and Managed Care Experience, Strong interpersonal and creative problem-solving skills, Excellent time management, highly organized with the ability to multi-task, Consistently meet required metrics and company goals, detailed-oriented, Ability to work under pressure and adapt to new challenges and/or processes, Mentoring junior representatives, Excellent Written and Verbal Communication, provide customer service satisfaction, compassionate and courteous, Microsoft Suite and Operating Systems.
Overview
9
9
years of professional experience
Work History
Claims Specialist
Brighton Health Plan Solutions
New York, NY
04.2023 - Current
- Maintained knowledge of policies and procedures and insurance coverage benefit levels, eligibility systems and verification processes.
- Communicated with other departments to establish action plans and manage open claims to closure.
- Planned and conducted investigations of claims to confirm coverage and compensation.
- Answered constant flow of customer calls with minimal wait times.
- Updated account information to maintain customer records.
- Utilized customer service software to manage interactions and track customer satisfaction.
- Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
- Conducted full claim investigations and reported updates and legal actions.
Health Navigator
Blue cross of Tennessee
Chattanooga, TN
03.2023 - 08.2023
- Provided patient education and counseling services to individuals in need of health navigation assistance.
- Documented patient information in appropriate systems to guarantee care coordination throughout patient care continuum.
- Scheduled patient appointments and specific treatments.
- Conducted health education sessions on the chat platform, offering valuable insight into preventive care,wellness strategies and disease management.
- Demonstrated proficiency in utilizing electronic EHR systems to maintain accurate and confidential patient records.
Senior Recovery/Resolution Representative
Optum, US Remote
01.2022 - 02.2023
- Provide claims expertise support by reviewing, researching, investigating, negotiating, and resolving all types of claims as well as recovery and resolution for health plan, commercial customers, and government entities
- Plan, prioritize, organize, and complete work to meet established production goals, quotas, and deadlines in a fast pace and ever-changing environment
- Ensure PRS is meeting the needs and expectations of the client; build a good rapport with the provider contacts by establishing professional working relationships to ensure timely recoveries
- Analyze, identify trends, and provide inventory and/or client updates as necessary
- Meet state and federal compliance policies, reimbursement policies, and contract compliance
- Works independently while acting as a resource and mentor for others.
Clinical Coordinator
Optum, US Remote
08.2015 - 01.2022
- Managed administrative intake of members or the admission/discharge information post notification
- Worked with hospitals, clinics, facilities, and the clinical team to manage requests for services from members and/or providers
- Managed the referrals process, processing incoming and outgoing referrals, and prior authorizations, including intake, notification, and census roles
- Received care coordination notification cases for non-clinical assessment/intervention and provide appropriate triage
- Reviewed requests for adverse determination, approval notification, and processing notification requirements
- Assisted the clinical staff with signing up documents/triage cases for Clinical Coverage.
VA Warehouse Specialist/Production
Genco, La Vergne, TN
La Vergne, TN
05.2015 - 08.2015
Technical Support/Sales Representative
Asurion, Nashville, TN
Nashville, TN
07.2014 - 05.2015
- Troubleshoot technical issues for customer's personal devices, evaluated concerns and issues, identified, and deploy solutions, as well as helped customer troubleshot
- Generated new business by selling product offerings to customers
- Communicated company policies and procedures
- Consistently met metrics and sales goals
- Cross trained in multiple departments to process customer service requests via phone support, email support or live chat when needed
- Documented customer correspondence in CRM to track requests, problems and solutions.
Education
Academic Diploma -
Skills
- Customer Service
- Data Entry
- Eligibility Determination
- Insurance Claim Forms Review
- Teamwork and Collaboration
- Attention to Detail
- Policy and Procedure Explanations
- Coverage Determination
- Information Verification
- Medical Terminology
- Understanding of Medical Terms
- Microsoft Office
- Verbal and Written Communication
- Data Entry Software
- Claims Processing
Timeline
Claims Specialist - Brighton Health Plan Solutions
04.2023 - Current
Health Navigator - Blue cross of Tennessee
03.2023 - 08.2023
Senior Recovery/Resolution Representative - Optum, US Remote
01.2022 - 02.2023
Clinical Coordinator - Optum, US Remote
08.2015 - 01.2022
VA Warehouse Specialist/Production - Genco, La Vergne, TN
05.2015 - 08.2015
Technical Support/Sales Representative - Asurion, Nashville, TN
07.2014 - 05.2015
Dyersburg High School - Academic Diploma,
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