
• Guide patients through the complexities of the healthcare system and help them find suitable primary care physicians and specialist doctors.
• Assist patients with updating coordination of benefits.
• Streamline the process for medical procedures by creating prior authorizations, pre-determinations, and inpatient notifications/admissions.
• Efficiently work under limited supervision in a cohesive team environment.
• Partner with third party administrators to ensure accuracy of claims status and prior authorizations.
• Review claims, plan benefit information and explanation of benefit statements with members and healthcare providers.
• Consistently achieve high weekly quality assurance monitoring scores.
• Consistently achieve weekly metrics for inbound/outbound calls, adherence, average handle time, average talk time & after-call work.
Ambitious, Dedicated & Goal Driven
Case Management Experience
Comprehensive Industry Knowledge
Claims Processing Experience
Efficient, Accurate & Highly Self-motivated
In-depth Ability to Think Clearly & Critically
Medical Insurance Experience
Over 18 years Experience in Customer Support
Strong Communication & Technical Writing Skills
Strong Decision Making & Problem Solving Skills
Strong Multitasking & Prioritization Skills
Team Oriented & Detail Oriented