Chauntell Montgomery

• Process international medical insurance claims, ensuring compliance with policy coverage, SLAs, and state/federal guidelines.
• Investigated claim details by reviewing documentation and interviewing involved parties.
• Collaborated with medical professionals to assess treatment necessity and coverage eligibility.

Communicate claim adjustment findings to providers, members, and internal teams with professionalism and clarity.

Claims Analyst | Jun 2021 – Jun 2024

• Reviewed and adjudicated 45+ daily claims across Medicaid, Medicare, and commercial lines using FACETS and Salesforce Health Cloud.
• Applied ICD-10/CPT coding and ensured correct payment or denial per established guidelines.
• Coordinated benefits and handled sensitive PHI in full compliance with HIPAA.
• Consistently met monthly KPIs in a deadline-driven environment.

• Managed client relationships and ensured satisfaction with services provided.
• Coordinated onboarding processes for new clients and streamlined communication.
• Conducted regular check-ins to assess client needs and address concerns.
• Collaborated with cross-functional teams to resolve client issues effectively.
• Managed escalated issues and provided clear, professional communication across channels.
• Managed multiple accounts simultaneously while meeting deadlines.
• Resolved customer complaints in a timely manner.
• Acted as main point of contact in matters relating to client concerns and needs.

• Supervised call center agents to ensure adherence to company policies.
• Trained new staff on communication techniques and system usage.
• Monitored call quality to maintain customer service standards.
• Resolved escalated customer issues to enhance satisfaction levels.
• Provided guidance, training, coaching and mentoring to call center team members.

• Developed training materials to enhance team knowledge and skills.
• Collaborated with management to improve customer satisfaction strategies.
• Conducted regular performance reviews to provide feedback and coaching.
• Identified opportunities for streamlining operational processes within the department; worked with stakeholders on implementing changes accordingly.