Brandi E. Folck
Eugene
Summary
Healthcare operations professional skilled in complex case review, escalation resolution, and regulatory compliance within managed care. Maintains documentation accuracy and drives policy-aligned outcomes. Collaborates effectively with utilization management, claims, and provider teams while managing high-risk work queues and ensuring audit-ready documentation.
Overview
2027
2027
years of professional experience
Work History
Customer Service Advocate IV
Centene / Health Net
2024 - Current
- Manage and resolve high‑complexity member and provider issues involving benefits, claims impact, and service eligibility, requiring detailed system review and documentation analysis.
- Maintain ongoing tracking and appropriate documentation in accordance with policies and guidelines
- Coordinate with Utilization Management, Claims, and Provider teams to resolve service-related issues by ensuring accurate documentation and eligibility.
- Act as a senior resource for complex cases and facilitate effective work queue management and timely progression of cases.
- Maintain accurate, complete case notes to support audits, escalation reporting, and compliance monitoring.
- Develop and lead team projects focused on process improvements, enhancing overall service delivery.
Escalation Response Specialist III
Centene / MET
2022 - 2024
- Managed high-risk, time-sensitive escalations affecting service access and case outcomes.
- Conducted root cause analysis to identify documentation gaps, system issues, or policy misapplication.
- Tracked trends and provided feedback to enhance workflow efficiency and resolution timeliness.
- Conducted research to enhance service offerings and improve customer satisfaction levels.
- Provided technical support for customers in resolving complex issues.
Customer Service Representative II
Centene / Trillium
2020 - 2022
- Interpreted coverage accurately to support benefit eligibility and service inquiries.
- Identified documentation discrepancies and routed cases for resolution efficiently.
- Managed high-volume calls while maintaining a positive customer experience.
- Escalated unresolved issues to appropriate departments for further assistance.
Customer Service Representative I
Centene / Health Net
2019 - 2020
- Delivered frontline healthcare support and developed foundational system and policy knowledge.
- Assisted members with inquiries regarding health benefits and services.
- Educated clients on plan coverage and eligibility requirements.
Education
Associate of Arts - Business
Lane Community College
Eugene, ORSkills
- Member Eligibility Analysis
- Regulatory Compliance
- Documentation review
- Escalation Resolution
- Audit Support
- Process Improvement
- Centene Systems and Workflow
- Case Documentation & Tracking Tools
- Microsoft Office proficiency
- Root Cause Analysis
- Cross-Functional Collaboration
- Project management
- Time management
- Conflict resolution
- Effective communication
- Team collaboration
Timeline
Customer Service Advocate IV
Centene / Health Net
2024 - Current
Escalation Response Specialist III
Centene / MET
2022 - 2024
Customer Service Representative II
Centene / Trillium
2020 - 2022
Customer Service Representative I
Centene / Health Net
2019 - 2020
Associate of Arts - Business
Lane Community College