Brandi Tellgren
Abilene,TX
Summary
Dedicated professional with over 9 years of experience in customer relations, adept at thriving in fast-paced environments. Known for meticulous attention to detail, strong decision-making skills, and a proactive approach to tasks. Comfortable collaborating with teams or working independently to ensure timely and accurate completion of projects. Demonstrated leadership abilities through effective communication, active listening, and adeptly managing multiple responsibilities simultaneously.
Overview
11
11
years of professional experience
Work History
Appeal Specialist
Blue Cross Blue Shield of Texas
Abilene, TX
02.2023 - Current
- Developed customized appeal letters tailored to each case''s unique circumstances, increasing the likelihood of successful outcomes.
- Monitored ongoing industry trends related to healthcare appeals management; staying current on best practices and adjusting strategies as needed to maintain effectiveness.
- Collaborated with team members to resolve complex cases, leveraging collective expertise and knowledge for optimal outcomes.
- Established rapport with insurance providers through regular contact during the negotiation process; fostering productive professional relationships that led to more favorable outcomes for clients.
- Expedited resolution times with well-organized case files that included all pertinent information related to each appeal submitted.
- Streamlined appeal processes, identifying areas for improvement and implementing necessary changes to increase overall efficiency.
- Contributed to ongoing process improvement initiatives within the department by proactively identifying inefficiencies and proposing actionable solutions.
- Enhanced customer satisfaction by providing timely and accurate responses to appeal inquiries and concerns.
- Reduced processing errors by meticulously reviewing claim documentation and ensuring adherence to company policies and guidelines.
- Assisted in training new hires on company procedures, policies, systems usage, resulting in faster acclimation for incoming staff members.
- Conducted comprehensive audits of denied claims; identifying patterns of inaccuracies or discrepancies that could be addressed proactively moving forward.
- Increased departmental productivity by prioritizing tasks effectively and maintaining strong attention to detail in all aspects of the appeal process.
- Acted as a reliable resource for colleagues in need of assistance or guidance on complex cases, fostering a collaborative and supportive work environment.
- Demonstrated adaptability in handling diverse caseloads, including medical necessity denials, coding disputes, authorization issues, and benefit determinations.
- Maintained strict confidentiality of sensitive patient information; ensuring compliance with HIPAA regulations at all times.
- Checked documentation for accuracy and validity on updated systems.
- Verified client information by analyzing existing evidence on file.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Carried out administrative tasks by communicating with clients, distributing mail, and scanning documents.
- Reviewed outstanding requests and redirected workloads to complete projects on time.
- Review procedure flows prior to getting published.
- Finalized level 2 appeals and integrated them into Adobe.
- Developed comprehensive claim charts.
- Facilitate level 2 appeals among supervisors and colleagues.
- Submit level 2 appeals to ERS executives.
- Handled FAF, email correspondence, and verbal appeals.
- Provider feedback to customer advocates.
- Edited level 2 letters to ensure accuracy before committee review.
- Issued letters of acknowledgment and determination to all involved in appeals.
ERS Personal Health Assistant (PHA)
BlueCross and BlueShield
Abilene, TX
02.2020 - 02.2023
- I assisted with TRS for 3-4 months as they transitioned from one insurance to BCBSTX within my first year.
- Answered questions on diverse topics, including authorization, referrals, and benefits, along with what the requirements are for their plan.
- Answered incoming member calls.
- I warm transferred calls to the appropriate area if they are not related to ERS medical.
- Process complex claims.
- Followed established guidelines and procedures.
- Participated in seminars and additional training to expand knowledge and skills.
- Utilized downtime to perform routine tasks, update any inventory, and work on additional training.
- Received training on provider-written inquiries
- I became a learning coach for new hires and provided feedback during training.
- I worked overtime.
- I sent letters to the corresponding parties.
- Called providers for participants to assist with any medical needs.
- Assisted other employees on provider written inquiries.
Motorclothes Associate
Motorclothes Associate, Kent's Harley Davidson Honda & Suzuki
Abilene, TX
09.2016 - 06.2020
- Facilitated communication by transferring calls and addressing inquiries.
- Managed inventory to meet customer needs.
- Balance cash drawer daily to ensure accuracy.
- Ensured store appearance remained tidy and clothes were well organized.
- Processed incoming inventory and entered data into system.
- Worked extended hours during company events to ensure customer satisfaction.
- Facilitated helmet fittings to ensure snug and perfect fit before purchase.
- Managed department operations during supervisor's absence.
Sales Associate
Sales Associate, Beall’s
Abilene, TX
02.2014 - 10.2016
- Welcomed customers and ensured they located desired items.
- Provided detailed descriptions of merchandise to enhance customer understanding.
- Guided customers in locating and obtaining merchandise tailored to their needs.
- Addressed inquiries about store products.
- Handled transactions with accuracy and speed.
- Coordinated special orders to fulfill customer requests.
- Managed cash register operations, including counting money and balancing cash drawers.
- Monitor and identify potential security threats and thefts.
- Monitored inventory and placed requisitions for new stock.
- Facilitated merchandise exchanges for customers.
- Handled packaging and gift wrapping tasks.
- Maintained cleanliness of shelves, counters, and tables.
Internet Help Desk
Internet Help Desk, Teleperformance
Abilene, TX
06.2016 - 09.2016
- Handled incoming calls and provided information to callers.
- Addressed and solved technical issues related to internet, landlines, and Wi-Fi.
- Assessed and confirmed network outages.
- Remotely accessed customer computers to resolve Wi-Fi issues.
- Scheduled technician visits to customer residences.
- Enabled new employees to gain insights by allowing participation in call listening sessions.
Education
Bachelor’s Degree - Business Administration And Management
Southern New Hampshire University
Manchester, NH08.2024
High School Diploma -
Hawley High School
Hawley, TX05.2016
Skills
- Call center experience
- Health products knowledge
- Detailing plans
- Customer service
- Claims
- Leader
- Sales expertise
- Organized and detail-oriented
- HIPAA guidelines
- Computer skills
- Microsoft (Word, Excel, and PowerPoint)
- Adaptability
- Feedback
- Adobe
Timeline
Appeal Specialist
Blue Cross Blue Shield of Texas
02.2023 - Current
ERS Personal Health Assistant (PHA)
BlueCross and BlueShield
02.2020 - 02.2023
Motorclothes Associate
Motorclothes Associate, Kent's Harley Davidson Honda & Suzuki
09.2016 - 06.2020
Internet Help Desk
Internet Help Desk, Teleperformance
06.2016 - 09.2016
Sales Associate
Sales Associate, Beall’s
02.2014 - 10.2016
Bachelor’s Degree - Business Administration And Management
Southern New Hampshire University
High School Diploma -
Hawley High School