Dawn Riley

Assisted members with claims processing. Communicated with providers to resolve inquiries. Completed claim submissions accurately and efficiently. Utilized daily systems including MedCompass, Makneese, GPS (Salesforce), AEPPays, AST/CXT, ClaimsXten (CXT), TPS, CPB, STARS, and Prospective Claim Accuracy (PCA). Navigated multiple screens to manage claims effectively. Applied medical terminology, ACAS coverage codes, CPT-10 codes, and HCPC updates for claims and COBS. Met established performance metrics.

• Reviewed, analyzed and prepared payments for accuracy and completeness prior to processing.
• Monitored daily payment activity in order to identify any discrepancies or errors.
• Processed payments using various methods such as ACH, Debit, and Credit Card.
• Setting up payment arrangements.
• Researched customer accounts to ensure that all payments were properly applied and reconciled.
• Assisted customers with inquiries regarding their payment status or account balances.
• Used salesforce to lookup customers information and orders to check for accuracy.
• Investigated customer complaints related to incorrect payments or billing disputes.

• Job responsibilities include; submitting and processing Web, & Siebel orders.
• Proficient in DESI/SABRE, Martens, INAT, Siebel, RMS, Adobe Standard 8, Microsoft Office 10, CRM.
• Confident in using the CSSR and COPP as resources to help with questions on procedures.
• I have also worked the following tasks; processing Low & Medium OM orders, Billing Modem Report, DSL Audits, Address Cards, Direct Pub report, Directory proofing, Sending Welcome & Thank You letters, D2D order entry, bill reprints, sending POR's on for approval, filing information to retention and MSS-APP task in Metasolv.
• Calling customers in regards to their phone and internet orders.