
Results-focused professional with strength in Customer service, accounting and tax preparation and relationships with the courts for purposes of community non profit management. Proactive leader with strengths in communication. Adept at managing concurrent objectives to promote efficiency and influence positive outcomes.
· Responds to inquiries from policy holders, providers and/or others for information and assistance.
· Performs research to respond to inquiries and interprets policy provisions to determine most effective response.
· Mails or routes claims forms and supporting documentation to various units for final processing.
· Independently responds to inquiries, grievances, complaints or appeals ranging from routine to moderate complexity.
· May seek assistance with complex customer services issues.
· Understand and interprets policy provisions.
· Performs research to respond to inquiries and interprets policy provisions to determine most effective response using established departmental procedures, HIPAA regulations, and corporate policies.
· Uses computer-based resources in a highly effective manner to educate and provide accurate responses to inquiries is crucial for success.
· Issue Emergency GOP (Guarantee of Payment) and COC (Certificate of Coverage) as required when it is necessary.
· Collaborate with other stakeholders / teams to resolve queries including complex queries.
· Actively support all team members to enable operational goals to be achieved.
· Meet or exceed Service Level Agreement requirements, team KPI(s), monthly quality audit scores and NPS (Net Promoter Score).
I have fully accomplished being the founder And active president of a nonprofit in 2019 that is a successful community organization with full partnerships with major metropolitan companies in the Dallas-Fort Worth metroplex.
Always Love Them This Much Inc.
Exciting Kilgore Baptist Church
PTA board member of Lancaster ISD
CFLE
Certified family life expert