Accomplished Coordination of Benefits Rep at UnitedHealthcare .Demonstrated ability to enhance inter-insurance coordination, significantly improving claims processing efficiency. Renowned for exceptional attention to detail and a professional demeanor, contributing to team success and reliable service delivery.
Overview
17
17
years of professional experience
Work History
Coordination of Benefits Rep
UnitedHealthcare
12.2017 - Current
Verify members eligibility and benefit information to determine primary and secondary coverage for Medicaid Members
Process claims for multiple states to coordinate benefits across multiple insurance plans for members enrolled in Commercial and Medicare Plans
Verify insurance coverage and communicate with other insurance to ensure accurate coverage dates for payment process f
Documented detailed notes about verification of member with each interaction with representatives from other insurance
Maintain accurate and up-to-date records of claims processing activities
Resolved issues and inquiries from plan participants regarding healthcare coverage and benefits.
Observed strict procedures to maintain data and plan participant confidentiality.
Checked members benefits for accuracy using Change Instamed and CMS. Input all data into Facets.
Enrollment Specialist
United Healthcare and Military Veterans
04.2013 - 12.2017
United Healthcare & Military Veterans is now the contractor that administers the TRICARE program to provide assistance to customers and assist with questions regarding all aspects of the TRICARE program
Provide assistance to TRICARE beneficiaries and to MTF staff members in relation to beneficiaries and other administrative matters between the MTF and United Healthcare
Update Tricare beneficiaries address and Primary Care Managers upon arrival to the MTF. Make changes in CCM (Customer Support Manager) and in Webdoes (Deers Online Enrollment Systems)
Assist customers with eligibility, benefits, and enrollment
Take enrollment fees and payments, assign members to a primary care manager assist with referrals and authorization and also with claims
Provided support and guidance to members regarding benefits, claims and other related inquiries
Supported staff by providing assistance during peak registration periods
Tricare Service Representative
TriWest Healthcare Alliance
12.2007 - 03.2013
Provide assistance to walk-in customers and assist with questions regarding all aspects of the TRICARE program
Provide assistance to TRICARE beneficiaries and the MTF staff members in relation to beneficiaries and other administrative matters between the MTF and TriWest
Assist with enrollment transfers from within the West Region and other TRICARE regions
Update members address and Primary Care Manager upon transfer to Travis AFB making changes in TACC (Tricare Application for Customer Care) and in DOES (Deers Online Enrollment Systems)
Assign members to Primary Care Manager, assist with referrals, authorizations and claims
Assist with consult tracking by collecting reports received by mail, fax or within the MTF. Make outbound calls to local network providers and input data regarding consult tracking
Ensure that the beneficiaries understand the grievance and appeals process when dissatisfied with provider, service or care
Maintain a working relationship with the MTF staff, document each beneficiary contact in TACC
Vice President, Network Management North Texas and Oklahoma at UnitedHealthcareVice President, Network Management North Texas and Oklahoma at UnitedHealthcare