ASHLEY H PATTERSON

• Reviews and processes insurance claims (wellness, Accident, and Hospital Indemnity) determines the nature and validity of claims by reviewing policy status, patient eligibility, and supporting medical and other documentation.
• Analyzes medical chart notes, provider bills, procedure codes, diagnosis codes, charges and medical records in order to determine validity of claim.
• Participated in quality assurance activities such as peer reviews and audits.
• Investigated discrepancies in claims and resolved issues with customers via telephone or written correspondence.

• Educated customers about products, pricing and policies to address and resolve issues. Managed customer conflicts and challenging situations by staying calm and accessing internal knowledgebase to develop solutions.
• Answered policy questions and performed troubleshooting, assisted clients via chat room or phone. Provided support with claims and claims coding, reviewed pended claim documents and advised insured/agents of information needed to process claims in question.
• Analyzed customer feedback data in order to make process improvements across departments.

• Processed Inbound/Outbound calls to provide continuous attention to customer needs to include making outbound calls to Providers for billing inquiries and making reservations for members. Processed, and adjusted medical claims, accepted and accessed medical records, and appeals from providers to determine medical necessity.

• Distributed team inventory, and reviewed calls for Quality audit surveys in support of meeting departmental goals and metrics

• Processed payments, assisted with financial needs, helping customers/agents with personal/business accounts.

• Resolved problems by clarifying issues; implemented solutions; escalated unresolved issues throughout the call center. Sold additional services by recognizing opportunities to up-sell accounts; Trained agents on new financial products and explained new features.

• Assisted with high profile Judicial Court calls to include leading conference calls, answering incoming internodes, and clearing bridges, and conducting video conferencing for company VIP clientele.

• Transcribed calls for clients to determine what may or may not be audible.