Carin Trotier-Keller

Engage with clients, brokers, and internal management to address and resolve all stop loss-related concerns effectively.

Evaluate reimbursement requests for accuracy and initiate appeals for denied claims as necessary.

Facilitate compilation and submission of initial, subsequent, and advance funding requests for 55 groups.

Updated and organized client activity reports to enhance visibility into requests, reimbursements, and denials for stakeholders.

Monitored request statuses and coordinated with carriers to resolve outstanding issues, ensuring timely claim processing.

Monitor request statuses and coordinate with carriers to address any outstanding issues.

Engaged with clients, brokers, and internal management to effectively resolve stop loss-related concerns, fostering strong relationships.

Update and organize client activity reports to provide clear visibility into requests, reimbursements, and denials.

Execute contract entries in Benefitfocus to facilitate accurate monthly reporting.

Analyze and post monthly performance reports to ERD, enhancing transparency and communication among brokers, clients, and carriers.

• Analyzed medical, dental, and vision claims for compliance with regulatory guidelines and internal policies, ensuring accurate processing and reimbursement.
• Analyzed medical claims for compliance with regulatory guidelines and internal policies.
• Collaborated with healthcare providers to clarify claim issues and resolve discrepancies, enhancing communication and reducing claim rejections.
• Led initiatives to streamline claims workflows, reducing processing time and enhancing cross-departmental collaboration.

Facilitated regular team meetings to align on goals, promote collaboration, and drive project completion.

• Trained new team members on company policies and procedures to ensure smooth onboarding.
• Provided coaching, feedback, and skill development opportunities to elevate team performance.
• Evaluated employee skills and knowledge regularly, training, and mentoring individuals with lagging skills.
• Evaluated employee skills and knowledge, mentoring individuals to address skill gaps.

Conducted audits on medical claims to ensure accurate coordination of benefits and pricing contract provisions, preventing financial discrepancies.

• Fostered supportive environment for junior associates, facilitating professional growth and knowledge exchange.
• Developed and delivered training sessions for new employees to enhance onboarding experience.