Chase Oldham

The Senior Appeals & Grievances Coordinator role involves liaising with various departments within the organization, external provider vendors, as well as the appellant to finalize the decision. Daily workload involves working cases including claims, appeals, medical records, legal documents, etc.
During my tenure I have consistently fulfilled all KPIs such as scoring 100% in quality audits. Some of my key skills that have allowed me to excel, include:

1. Time Management: The role involves managing multiple cases through the 60-day appeal lifecycle. The ability to prioritize tasks, manage time effectively, and meet deadlines is crucial.

2. Attention to Detail: The role requires careful attention to detail to ensure that all necessary information is gathered and considered in the appeal decision-making process.

3. Critical Thinking: The role involves analyzing complex medical and legal information to reach a decision. The ability to think critically, analyze information, and consider multiple perspectives is important.

4. Communication: Effective communication is essential for this role. Senior appeals representatives must communicate effectively with various departments within the organization, external vendors as well as the appellant, to finalize decisions.

5. Teamwork: The role requires working collaboratively with team members to ensure that appeals are processed accurately and efficiently.

6. Adaptability: The healthcare industry is constantly evolving, and the ability to adapt to changes in regulations, policies, and procedures is important for success in this role.

Assisted customers with benefits, enrollments, payments, claims, authorizations/referrals, and reinstatements.
Collaborated with multiple departments to resolve complex issues and stayed informed about industry changes.
Consistently fulfilled all metrics in this highly matrixed environment. Key Skills that assisted my success included:
1. Excellent Communication: Clearly expressed ideas, listened attentively, and responded effectively to customer needs.
2. Empathy: Addressed customers' emotions and needs with understanding and kindness.
3. Problem-Solving: Quickly identified issues and implemented effective solutions to ensure customer satisfaction.
4. Interpersonal Skills: Built meaningful connections with customers and colleagues.
5. Conflict Resolution: Managed and resolved customer conflicts efficiently.
6. Multitasking: Handled various tasks concurrently without compromising quality.

• Responsible for meeting weekly sales targets and ensuring that cash deposits to the bank matched the sales reports with 100% accuracy.
• Created and shared daily Excel reports with the head office to track sales. Managing inventory efficiently was crucial, especially with ensuring compliance with health codes and state regulations.
• Success in this role was driven by my attention to detail, strong customer service skills, and ability to handle pressure during busy sales periods.
• Effectively delegated tasks to other staff members, fostering a friendly yet professional working environment.