Cherrelle Mason
Fort Lauderdale,FL
Summary
Assisted customers with healthcare inquiries and case management for over 10 years. Supported effective communication and problem-solving to enhance customer satisfaction. Utilized empathy training and CRM skills to improve member experiences.
Spearheaded case management initiatives, specializing in utilization review and healthcare claims management.
Overview
6
6
years of professional experience
Work History
Case Manager
McKesson Specialty Health
West Palm Beach, US
07.2024 - Current
- Manage and following up on utilization reviews, prior authorizations, healthcare claims, and appeals.
- Monitors and manages pending utilization review and prior authorization requests, ensuring timely submission and follow-up.
- Specializes in assisting customers, mainly through diagnosing and solving issues using their product and service expertise.
- In most companies, they communicate with clients through calls or correspondence.
- Through this, they get to identify their needs, answer inquiries, give technical advice, troubleshoot problems, and solve issues and concerns, ensuring efficiency and client satisfaction.
- Moreover, a technical support advisor works together with the company's internal departments to optimize customer support operations and resolve any issues or vulnerabilities in the current procedures.
- Streamlined remote technical support operations by implementing systematic troubleshooting protocols and resolving complex customer issues through detailed analysis.
- Provided comprehensive technical guidance to diverse clientele, developing tailored solutions and maintaining strong customer relationships.
- Resolve complex member inquiries at first contact while maintaining strict confidentiality, enhancing service efficiency and member satisfaction.
- Partner with members to identify optimal health solutions, utilizing advanced interpersonal skills and product expertise to address diverse healthcare needs.
- Deliver personalised member support, resolving complex healthcare inquiries while maintaining strict confidentiality and fostering trust-based relationships.
- Drive member satisfaction through swift resolution of healthcare benefit inquiries, implementing effective solutions and maintaining service excellence.
- Collaborates closely with healthcare providers to gather necessary information and/or documentation required for reviews or appeals.
- Tracks and documents the status of requests, denials, and appeals in the company's database or system.
- Communicates with insurance companies to obtain status updates, resolve issues, and expedite approvals.
- Follows up on outstanding healthcare claims, ensuring accurate processing and payment.
- Acts as the liaison with patients to inform them of the status of their requests, potential coverage issues, or any additional information required.
- Assists in the appeals process by gathering required documentation, submitting appeals, and tracking outcomes.
- Coordinator to provide insights and improve the utilization review process, as needed.
- Drive case resolution efficiency through methodical analysis and swift problem-solving, ensuring optimal client satisfaction and process improvement.
- Streamlined utilization review processes by implementing systematic tracking methods, reducing pending authorization time and improving claim resolution efficiency.
- Maintained comprehensive documentation of healthcare claims, appeals, and authorization requests while ensuring compliance with regulatory requirements.
- Coordinated patient care plans with healthcare teams and specialists.
- Assessed patient needs and developed tailored support strategies.
- Managed case documentation and maintained compliance with regulations.
Member Support Specialist /cx specialist
NationsBenefits
Remote
07.2021 - 06.2024
- Respond swiftly and courteously to all potential customer inquiries
- Utilize interpersonal skills to establish a strong relationship that allows for direct probing to uncover the member's needs
- Resolve member inquiries at the first point of contact
- Utilize effective sales techniques to influence the member to take action
- Ability to learn product portfolio quickly and discuss options and features in detail
- Provide knowledge and in-depth advice for hearing loss and hearing aids
- Educate members on products or services that will enhance their quality of life
- Show empathy both in word choice and intonation to all Members
- Strong ability to offer a sales rebuttal that addresses a member's objections and, in turn, presents solutions
- Ability to remain confidential with all proprietary information
- Helping health plan members achieve a better quality of life through supplemental benefit solutions. We are also passionate about supporting the goals of our associates and helping them do their best work.
Member Services Coordinator
Union Health
Remote
12.2019 - 06.2021
- Conducted comprehensive onboarding and orientation sessions to foster member engagement and improve retention rates.
- Facilitated prompt and effective resolution of member inquiries across diverse platforms, improving overall member satisfaction.
- Oversaw the creation and regular updates of resources, ensuring enhanced information accessibility for all members.
- Implemented strategic initiatives to refine membership processes, resulting in increased operational effectiveness.
- Analyzed client needs and delivered tailored product and service recommendations to ensure optimal alignment with unique specifications.
- Facilitated member satisfaction by efficiently resolving inquiries and delivering tailored solutions to address concerns.
- Monitored customer satisfaction by systematically following up on resolved issues and promptly addressing any lingering concerns.
- Clarified billing payment processing and support policies and procedures for customers to ensure informed decision-making.
Education
Associate - Business Management
Broward College
Skills
- Achieved enhanced customer satisfaction by optimizing CRM software functionalities Increased team efficiency by implementing best practices in CRM usage Delivered improved insights into customer behavior through effective data analysis
- Achieved high tenant satisfaction rates through proactive property management practices Improved operational workflows, resulting in enhanced service delivery Cultivated strong relationships with tenants, fostering a positive community environment
- Achieved high customer satisfaction ratings through effective problem resolution Enhanced service delivery by streamlining communication
- Executed communication initiatives to ensure clarity and alignment among stakeholders
- Developed and maintained organized systems for tracking time allocation across various projects
- Managed data entry operations, maintaining high standards of accuracy and attention to detail
- Interpreted and implemented medical terminology to ensure precise understanding in healthcare settings
- Diagnosed and addressed technical problems, ensuring optimal performance of software and hardware systems
- Analyzed transaction patterns and anomalies to enhance fraud detection capabilities
- Facilitated collaborative problem-solving sessions to drive innovative solutions and improve team performance
- Achieved improved team performance by fostering an environment of empathy and understanding Enhanced collaboration through effective communication strategies that addressed team members' needs Strengthened relationships within the team, leading to increased morale and productivity
- Achieved improved employee performance through effective training programs Enhanced team collaboration by implementing knowledge-sharing sessions Increased employee satisfaction by providing tailored training opportunities
- Developed adaptive solutions to address evolving project requirements
- Implemented strategies for effective conflict resolution, promoting positive interpersonal relationships
- Analyzed existing processes and identified opportunities for improvement to elevate overall performance
- Analyzed patient data and treatment plans during utilization reviews to identify opportunities for improved healthcare delivery
- Coordinated and monitored case management initiatives, focusing on client needs and resource allocation
- Facilitated collaborative problem-solving sessions to enhance team decision-making
- Reviewed and updated case documentation to maintain compliance with regulatory standards and improve case tracking
- Utilized active listening skills to accurately interpret and respond to client needs and concerns
- Analyzed data and trends to drive effective decision-making in organizational initiatives
- Engaged with stakeholders to build trust and facilitate effective communication
- Implemented strategies for effective conflict resolution, promoting positive interpersonal relationships
- Demonstrated a positive attitude to support effective communication
- Developed and implemented strategies for effective client advocacy, promoting client interests and satisfaction
- Managed patient care coordination efforts, ensuring seamless communication and collaboration among healthcare providers
- Employed critical thinking techniques to assess situations, identify challenges, and propose strategic recommendations
- Achieved high levels of patient satisfaction through dedicated support and advocacy Enhanced patient care processes by collaborating with healthcare professionals to address individual needs Fostered a supportive environment that promoted patient recovery and well-being
- Conducted regular audits and training sessions to promote understanding and enforcement of HIPAA compliance across the organization
- Analyzed applicant information and documentation to accurately assess eligibility for services
- Time management
- Conflict resolution
Personal Information
Timeline
Case Manager
McKesson Specialty Health
07.2024 - Current
Member Support Specialist /cx specialist
NationsBenefits
07.2021 - 06.2024
Member Services Coordinator
Union Health
12.2019 - 06.2021
Associate - Business Management
Broward College