Chrischana Francois
Homestead,FL
Summary
Versatile professional skilled in adapting to challenges and fostering relationships with clients and team members. Focused on driving team success through innovative problem-solving and analytical thinking. Committed to continuous learning and delivering impactful solutions in fast-paced environments.
Overview
11
11
years of professional experience
Work History
Medical Underwriter (Remote)
Maximus
Homestead, Florida
12.2024 - Current
- Applied underwriting guidelines to assess policy risk and coverage decisions.
- Assessed financial risks associated with new policies by analyzing customer applications and related documents.
- Reviewed medical records for Maximus health program eligibility.
- Interpreted clinical documentation for accurate medical necessity reviews.
- Evaluated applicant histories for preexisting conditions and coverage limits.
- Evaluated claims data to determine the extent of benefits available under various policies.
- Performed complex calculations involving premium costs, deductibles, and copayments in order to accurately price policies.
- Documented underwriting decisions in secure claims and case systems.
- Maintained accurate records related to underwriting activities including review notes, correspondence.
- Ensured HIPAA compliance across confidential underwriting file reviews.
- Communicated request findings to internal teams and external partners.
- Drafted letters informing clients of approval and denial status along with explanation of the rationale behind the decision-making process.
- Provided guidance to customers on obtaining appropriate coverage for their unique circumstances.
Benefits Verification Specialist (Remote)
Cardinal Health
Homestead, Florida
12.2022 - 12.2024
- Secured prior authorization details from payers to facilitate medication and treatment coverage.
- Verified insurance eligibility and benefits for Cardinal Health pharmacy service requests.
- Reviewed patient demographics and coverage records for accuracy before benefit review.
- Documented insurance findings and case notes in electronic billing systems.
- Collaborated with pharmacies, physicians, and payers to address and resolve coverage inquiries.
- Explained benefit requirements and authorization steps to patients and internal teams.
- Tracked claim issues and followed up on pending payer responses.
- Adhered to HIPAA regulations when handling confidential patient information.
- Applied HIPAA standards while handling sensitive member and provider information.
- Delivered comprehensive information on insurance plans and benefits to healthcare providers, patients, and staff.
- Initiated contact with insurance companies to obtain additional information for verification purposes.
- Processed and tracked patient benefit claims according to established procedures.
- Organized and prioritized daily workloads to meet management deadlines. while meeting deadlines set by management.
Claims Processing Specialist (Remote)
Florida Blue - Blue Cross Blue Shield Of Florida
Homestead, FL
08.2021 - 12.2022
- Reviewed Blue Cross Blue Shield claims for eligibility, coding, and payment accuracy.
- Applied Florida Blue processing rules to complex healthcare claim decisions.
- Supported Florida Blue medical claim processing using benefit guidelines and policy procedures.
- Checked claim files for missing documents and supporting records to ensure accurate processing.
- Coordinated claim status updates with adjusters, providers, and members to improve communication and resolution speed.
- Answered member and provider claim questions through clear written updates.
- Investigated, researched and responded to customer inquiries regarding billing issues.
- Documented claim processing activities in accordance with established procedures.
- Adhered to HIPAA privacy standards when handling confidential patient information.
- Worked collaboratively with other departments such as customer service and coding staff.
- Developed strategies to streamline claim submission and payment processes, enhancing overall turnaround time.
- Performed data entry into various systems related to claims processing tasks.
Benefits Specialist (Remote)
Molina Healthcare
Doral, Florida
01.2020 - 08.2021
- Explained benefit options and coverage details, assisting members and providers in informed decision-making.
- Reviewed eligibility for medical insurance coverage and other benefit plans.
- Processed member eligibility and enrollment updates to ensure accurate benefits access.
- Resolved complex benefits inquiries using health plan policies.
- Reviewed member records for accuracy and completeness, ensuring compliance with documentation requirements.
- Coordinated with claims and service teams on benefits questions.
- Interpreted plan documents, summaries, and enrollment materials.
- Tracked benefit cases and maintained confidential member information.
- Processed benefit enrollment forms, changes, and terminations.
- Checked accuracy and completeness of benefits applications and documents.
- Explained the impact of life events such as marriage or divorce on benefits enrollment status.
Claims Representative
Assurant Solutions
Cutler Bay, Florida
01.2017 - 01.2020
- Processed a high volume of claims efficiently while maintaining quality standards.
- Reviewed and verified claim information to ensure accuracy of data and compliance with established policies.
- Evaluated supporting documents for damage, loss, and claim validity.
- Explained claim requirements and next steps to customers clearly.
- Provided quality customer service to assigned, insured and claimants throughout the claims process to deliver timely service to customers.
- Communicated claim status updates to policyholders and service partners.
- Handled customer inquiries regarding insurance policy coverage details and payment status updates.
- Maintained detailed records of all communication with customers, claimants, providers, and internal departments.
- Reviewed Assurant Solutions claims files for coverage and policy eligibility.
- Provided clear explanations of benefits, eligibility requirements, and applicable laws when communicating with customers.
- Documented changes in claim statuses using specialized software systems.
- Filed appeals on behalf of customers after claim denial due to insufficient evidence.
- Resolved complex discrepancies in policyholder files to facilitate accurate claim processing.
- Processed claim intake and entered customer information into claims systems.
Sales Associate
Alorica
Cutler Bay, Florida
06.2015 - 12.2016
- Promoted products and services during customer conversations.
- Applied product knowledge to recommend suitable service options.
- Supported customer retention through courteous problem solving and follow-up.
- Resolved account questions through active listening and clear communication.
- Addressed customer complaints professionally in a professional manner.
- Documented customer details in CRM systems accurately.
- Supported inbound customer calls for Alorica by following sales scripts and service guidelines.
Education
High School Diploma -
Homestead Senior High School
Homestead, FL06-2015
Some College (No Degree) -
Valencia College
Orlando, FLTimeline
Medical Underwriter (Remote)
Maximus
12.2024 - Current
Benefits Verification Specialist (Remote)
Cardinal Health
12.2022 - 12.2024
Claims Processing Specialist (Remote)
Florida Blue - Blue Cross Blue Shield Of Florida
08.2021 - 12.2022
Benefits Specialist (Remote)
Molina Healthcare
01.2020 - 08.2021
Claims Representative
Assurant Solutions
01.2017 - 01.2020
Sales Associate
Alorica
06.2015 - 12.2016
High School Diploma -
Homestead Senior High School
Some College (No Degree) -
Valencia College