DEDREK BURKE
Apopka
Summary
Adaptable professional with multiple years of work experience and proven knowledge of leadership, problem-solving, and workflow prioritization. Aiming to leverage my abilities to successfully fill the role at your company.
Overview
9
9
years of professional experience
Work History
Prior Authorization Representative II
Elevance Health
01.2024 - Current
- Verified eligibility and compliance with authorization requirements for service providers.
- Processed new medication and refill requests for authorization.
- Improved patient satisfaction by efficiently processing prior authorization requests and ensuring timely responses.
- Streamlined workflow for faster approval turnaround times.
- Supports utilization management team to document authorization requests and obtain accurate and timely documentation for services related to the members healthcare eligibility and access
- Aids the utilization management team and maintains ongoing tracking and appropriate documentation on authorizations referrals in accordance with policies and guidelines
- Supports the authorization review process by researching and documenting necessary medical information such as history, diagnosis, and prognosis based on the referral to the clinical reviewer for determination
Sales Development Representative
ThreatLocker
05.2022 - Current
- Experienced in Saas Working with global cybersecurity leader to improve the security of servers and endpoints.
- Providing enterprise-level cybersecurity tools for the Managed Services Provider (MSP) industry.
- Built and managed accurate sales pipeline to maintain high volume of activity.
- Worked with sales team to collaboratively, consistently meeting or exceeding personal quotas. Cold called potential customers to generate leads.
Account Manager
Tetra Tech
04.2021 - 05.2022
- Answer applicants' questions about benefits and claim procedures.
- Compile, record, and evaluate personal and financial data in order to verify completeness and accuracy, and to determine eligibility status.
- Interview and investigate applicants for public assistance to gather information pertinent to their applications.
- Check with employers or other references to verify answers and obtain further information. Keep records of assigned cases, and prepare required reports.
- Compute and authorize amounts of assistance for programs such as grants, monetary payments, and food stamps. Investigate claimants for the possibility of fraud or abuse.
Account Manager
AssistRX
09.2019 - 01.2021
- Resolve complex, severe exposure claims, using high service oriented file handling.
- Pay and process claims within designated authority level. Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.
- Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.
- Maintain claim files such as records of settled claims and an inventory of claims requiring detailed analysis.
- Report overpayments, underpayments, and other irregularities. Prepare reports to be submitted to company's data processing department.
Verification Specialist
Alliance RX Walgreens Prime
02.2018 - 08.2019
- Review and verify data, such as age, name, address, and principal sum and value of property on insurance applications and policies.
- Modify, update, and process existing policies and claims to reflect any change in beneficiary, amount of coverage, or type of insurance.
- Calculate premiums, refunds, commissions, adjustments, and new reserve requirements, using insurance rate standards.
- Examine letters from policyholders or agents, original insurance applications, and other company documents to determine if changes are needed and effects of changes.
- Review insurance policy to determine coverage.
- Post or attach information to claim file.
Customer Service Representative
Conduent
06.2016 - 02.2018
- Determine if changes are needed and effects of changes
- Review insurance policy to determine coverage.
- Post or attach information to claim file.
- Keep records of customer interactions or transactions, recording details of inquiries, complaints, or comments, as well as actions taken
- Check to ensure that appropriate changes were made to resolve customers' problems
- Determine charges for services requested, collect deposits or payments, or arrange for billing
- Refer unresolved customer grievances to designated departments for further investigation.
Education
Master Of Business Administration (M.B.A.) - Business
Penn State
University Park, PA05.2011
Timeline
Prior Authorization Representative II
Elevance Health
01.2024 - Current
Sales Development Representative
ThreatLocker
05.2022 - Current
Account Manager
Tetra Tech
04.2021 - 05.2022
Account Manager
AssistRX
09.2019 - 01.2021
Verification Specialist
Alliance RX Walgreens Prime
02.2018 - 08.2019
Customer Service Representative
Conduent
06.2016 - 02.2018
Master Of Business Administration (M.B.A.) - Business
Penn State
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