Ashley Layne
Lyles,TN
Summary
Dedicated problem-solver with a strong ability to analyze complex issues and understand their underlying mechanisms. Eager to apply this enthusiasm and my expertise in data analytics to contribute effectively to your team. Experienced with appeals processing and regulatory compliance. Utilizes analytical skills and effective communication to facilitate dispute resolution. Knowledge of workflow optimization to improve efficiency and resolution times.
Overview
5
5
years of professional experience
Work History
Complaint and Appeals Coordinator
Aetna
11.2022 - Current
- Completed IPA cases requiring thorough data gathering and meticulous attention to detail
- Handled standard cases in the queue, including contract and agreement reviews
- Verified all necessary approvals and paperwork were included before routing to the appropriate person for resolution
Member Service Agent
Travel Resorts America
11.2021 - 11.2022
- Reviewed and updated account information, ensuring accuracy and completeness
- Conducted contract reviews for account support
- Gathered and managed billing information
- Triaged initial contact, escalating as necessary
- Collaborated extensively with field support agents
Reservationist
Travel Resorts America
09.2020 - 11.2021
- Assisted users in locating and reserving facilities based on specific requirements and special considerations
- Provided excellent customer service to ensure user satisfaction
Education
Associates Degree - Early Childhood Education
Chattanooga State
05.2009
Skills
Verbal and Written: Effectively communicating with clients, providers, and internal teams to resolve issues and provide clear explanations
Active Listening: Understanding the nuances of complaints and appeals to address concerns accurately
Investigation: Thoroughly researching and gathering information to understand the root cause of issues
Critical Thinking: Analyzing information and applying logic to make sound decisions and resolve problems
Problem Solving: Developing and implementing solutions to address complaints and appeals effectively
Timeline
Complaint and Appeals Coordinator
Aetna
11.2022 - Current
Member Service Agent
Travel Resorts America
11.2021 - 11.2022
Reservationist
Travel Resorts America
09.2020 - 11.2021
Associates Degree - Early Childhood Education
Chattanooga State