Byonne M. Bavis
Lake Elsinore,CA
Summary
Service-driven professional highly informed of all state and federal regulations pertaining to benefits for employees. Communicative Benefits Specialist offering outstanding customer service and data confidentiality skills. Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
9
9
years of professional experience
Work History
Case Manager
Kaiser Permanente (contractor)
Corona, CA
11.2024 - Current
- Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
- Conducted thorough assessments of clients'' situations, identifying issues, goals, and necessary interventions.
- Monitored ongoing cases closely, adjusting case management strategies as needed based on evolving circumstances or new information.
- Delivered comprehensive information on Continuity of Care program.
- Fostered open lines of communication with the members and providers, involving them in the case management process as appropriate.
- Review charts, provider regions, and referrals in Health Connect.
- Coordinated on accurate procedural coding and provider information.
- Ensure compliance with company policies, HIPAA, and other regulatory requirements.
- Utilization review & medical necessity criteria
Review Coordinator & Senior Customer Service Rep.
Cigna Healthcare
Bloomfield, CT
01.2023 - 11.2024
- Contributed to continuous improvement initiatives aimed at enhancing overall operational efficiency within the organization.
- Utilized effective listening skills to identify underlying needs or preferences of customers for personalized assistance.
- Managed multiple tasks simultaneously, prioritizing workload effectively to meet deadlines.
- Contributed towards overall team success by consistently exceeding performance metrics such as quality scores, resolution times, and customer satisfaction ratings.
- Met customer call guidelines for service levels, handle time and productivity.
Remote Benefits Analyst
UnitedHealth Group
09.2022 - 04.2023
- Tediously processed multiple claims daily
- Audited claims and plans created to make sure they are good to go live
- Installed benefits accurately in the system to ensure claims are paid and benefits are quoted to members
- Met members' needs to access benefits, analyzed benefit information, and coded into various systems.
- Offered subject matter expertise on employment regulations, compensation policies and personnel management procedures to optimize internal structures.
- Coordinated benefits processing, including enrollments, terminations and claims.
- Provided assistance to plan participants by explaining benefits information to ensure educated selections.
- Mastered state and Federal benefit laws Including ERISA, FMLA, COBRA, HIPPA and 401k administration.
- Assisted with audits by preparing accounts and providing information.
- Evaluated efficiency and value of current benefit programs and made recommendations for improvement.
- Kept operations in compliance with requirements by applying knowledge of applicable regulations, legal statutes and tax code information.
Remote Senior Dispatcher
Marathon Global logistics
Richmond, VA
03.2020 - 06.2022
- Managed 50-100 inbound and outbound calls a day
- Tracked changes in computer system to keep records current and accurate
- Kept detailed and updated records of calls in physical and electronic databases
- Reviewed routes, traffic, and weather conditions to adjust plans, meeting requirements and service needs
- Embraced, promoted, and led continuous improvement efforts to establish drivers and trucks utilized to maximum potential.
- Scheduled loads according to priority and available equipment.
- Monitored dispatch board and adjusted call priorities regularly based on caller needs.
- Utilized various software systems to facilitate movement, planning and scheduling.
- Kept detailed and updated records of calls in physical and electronic databases.
- Reviewed routes, daily traffic and weather conditions to adjust plans, meeting daily requirements and service needs.
- Supervised driver dispatching, route planning and vehicle tracking for over eight drivers.
- Monitored changes in delivery schedule and communicated changes to customers.
- Worked closely with transportation supervisor to dispatch and assign loads.
- Answered customer requests with information about product availability, shipping information and status updates.
- Identified locations and needs of callers to accurately send assistance.
- Tracked changes in computer system to keep records current and accurate.
- Liaised with customers to provide logistics for drivers and coordinate delivery times.
Claims and Appeals Coordinator
Alignment Healthcare
Cerritos, CA
02.2016 - 06.2021
- Performed 50-75 calls and 40-60 physician and hospital claims per day
- Ensured that all insurance information needed for billing and collection processes are appropriately obtained and recorded in the computer system
- Contacted insurances to check eligibility and confirm insurance status via online portals or over the phone
- Informed patients of their financial responsibility for services to be rendered
- Verified all referrals were completed
- Created and maintained business relationships with medical providers
- Managed a wide variety of customer service and admin tasks to resolve issues quickly and efficiently
- Navigated through various databases and programs for updating and maintenance daily.
- Verified details with policyholders and requested additional information.
- Identified reasons behind denied claims and worked closely with insurance carriers to promote resolutions.
- Acted as intermediary between insurance companies and customers by researching and assessing information to determine claim validity.
- Monitored reports to identify claims issues and worked with adjusters to resolve problems.
- Assisted claimants, providers and clients with problems or questions regarding claims.
- Checked documentation for appropriate coding, catching errors and making revisions.
- Collaborated with fellow team members to manage large volume of claims.
- Coordinated and planned investigations of claims to confirm compensability and coverage.
- Retained strong medical terminology understanding in effort to better comprehend procedures.
Senior Patient Care Coordinator
HealthCare Partners Medical Group
Costa Mesa, CA
06.2018 - 10.2019
- Medical reason, recovered)
- Completed 50+ calls each day
- Scheduled evaluations, procedures, or classes for patients
- Verified insurance and obtained and checked status of authorizations
- Communicated with patients to ensure quality of care and develop care plans
- Liaised effectively with patients, doctors, and staff members, assessing medical charts and promoting high level of communication and interaction
- Resolved conflicts between physicians, nurses, and administrative staff to maintain optimal workflows
- Implemented new hire training to further develop skills and initiate discussions on task prioritization.
Appeals and Grievances Coordinator
CalOptima
Orange, CA
01.2018 - 03.2018
- Handled 100+ queued calls and 60+ UB04 and 1500 claims regularly
- Completed open enrollment and checked claims and prior authorizations
- Researched disciplinary and grievance issues and recommended optimal courses of action
- Contacted customers to gather information, communicate disposition of case, and document interactions
- Generated written correspondence to customers such as members, providers, and regulatory agencies
- Prioritized and organized tasks to efficiently accomplish service goals.
- Mediated or arbitrated discussions between parties in cases of labor disputes.
- Worked successfully with diverse group of coworkers to accomplish goals and address issues related to our products and services.
- Maintained updated knowledge through continuing education and advanced training.
- Provided excellent service and attention to customers when face-to-face or through phone conversations.
Workers' Compensation Claims Specialist/Loan Processor
Credit Union
Garden Grove, CA
10.2016 - 02.2017
- Examined claims, records and procedures to grant approval of coverage.
- Collaborated with fellow team members to manage large volume of claims.
- Organized information by using spreadsheets, databases or word processing applications.
- Prepared and reviewed insurance-claim forms and related documents for completeness.
- Input claim information and payments into company database.
- Reviewed policies to determine appropriate levels of coverage and assist with approval or denial decisions.
- Drafted statement of loss to summarize damages, payments and underlying policy coverage.
- Analyzed information gathered by investigations and reported findings and recommendations.
- Contacted banks to acquire credit information.
Education
High School Diploma -
Long Beach Polytechnic High School
Long Beach, CASkills
- Benefits Interpretation
- Open Enrollment
- Verbal and Written Communication
- Supervision & Leadership
- Planning & Organizing
- People Skills
- Training & Development
- Computer Skills
- Data Management
- Organizational Skills
- Customer Service
- Microsoft Office
- Good Work Ethic
- Problem Resolution
- Ability to work in a fast-paced, deadline-driven environment
Timeline
Case Manager
Kaiser Permanente (contractor)
11.2024 - Current
Review Coordinator & Senior Customer Service Rep.
Cigna Healthcare
01.2023 - 11.2024
Remote Benefits Analyst
UnitedHealth Group
09.2022 - 04.2023
Remote Senior Dispatcher
Marathon Global logistics
03.2020 - 06.2022
Senior Patient Care Coordinator
HealthCare Partners Medical Group
06.2018 - 10.2019
Appeals and Grievances Coordinator
CalOptima
01.2018 - 03.2018
Workers' Compensation Claims Specialist/Loan Processor
Credit Union
10.2016 - 02.2017
Claims and Appeals Coordinator
Alignment Healthcare
02.2016 - 06.2021
High School Diploma -
Long Beach Polytechnic High School