Chris Wall
Citrus Heights,CA
Summary
Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.
Overview
19
19
years of professional experience
Work History
Appeals and Grievances Representative, Advanced
Blue Shield of California
05.2021 - Current
- Assist with inquiries regarding member appeals.
- Respond to appeals in grievances and member reconsiderations.
- Research, review, and resolve high level/high priority member grievances, appeals and complaints, while clarifying issues and educating customers in the process.
- Interpret and explain health plan benefits, policies, procedures, and functions to members and providers.
- Administer ongoing grievance tracking, trending, and reporting for assigned grievances.
Customer Services Concierge Support, Intermediate
Blue Shield of California
08.2020 - 05.2021
- Resolve incoming calls concerning member eligibility, benefits, provider information, and clinical requests.
- Compose routine and non-routine correspondence to answer benefits/provider inquiries in writing.
- Coordinate membership changes such as member's primary care physician.
- Analyze available programs, determine program eligibility, and connect member to appropriate BSC Vendors, Health Advocates, and Social workers.
- Execute prior authorization requests.
- Perform back-end claims processing using knowledge of system applications and documented workflows to resolve edits accurately.
- Responsible for special processing assignments.
Senior Account Manager
States Recovery Systems
02.2006 - 08.2020
- Maintained accurate records of customer accounts, payments and payment plans.
- Recognized as a top performer within the team for consistently surpassing goals and maintaining high levels of client satisfaction.
- Negotiated with account holders to devise repayment plans and minimize collections receivables.
- Analyzed customer financial records to determine appropriate payment plan.
Education
Health Care Administration
The University of Arizona Global Campus
Chandler, AZ11.2025
High School Diploma -
San Juan High School
Citrus Heights, CA06.2000
Skills
- Flexible and Adaptable
- Policy Knowledge
- Grievance management
- Multitasking
- Analytical and Critical Thinking
- Dependability
Timeline
Appeals and Grievances Representative, Advanced
Blue Shield of California
05.2021 - Current
Customer Services Concierge Support, Intermediate
Blue Shield of California
08.2020 - 05.2021
Senior Account Manager
States Recovery Systems
02.2006 - 08.2020
Health Care Administration
The University of Arizona Global Campus
High School Diploma -
San Juan High School
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