De'Jaa Daniel
Fort Meade,Maryland
Summary
Brings proven track record of success in determining eligibility and resolving complex cases. Works professionally with clients to develop and implement successful strategies for maximizing services and benefits. Skilled in problem-solving and identifying solutions meeting clients' needs.
Overview
5
5
years of professional experience
Work History
Authorization Specialist
SafeRide Health
04.2021 - Current
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Communicated with people from various cultures and backgrounds on Meals & Lodging benefit processing.
- Kept records of members' Inpatient and Outpatient authorizations for continuation of care.
- Contacted provider offices and social workers about verifying appointment information and updated services, answered questions and resolved concerns to uphold exceptional customer service standards.
Referral Specialist
Centene, Superior Health Services
08.2019 - 03.2021
- Create Authorizations for inpatient services.
- Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
- Build profiles for all NICU babies.
- Processing over 40+ authorizations in a day.
Customer Service Representative
ANTHEM Health Services
08.2019 - 06.2020
- Handled customer inquiries and suggestions courteously and professionally.
- Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
- Answered constant flow of customer calls with minimal wait times.
- Answered customer telephone calls promptly to avoid on-hold wait times.
- Filed and maintained patient records in accordance with HIPAA regulations.
- Verified insurance eligibility and coverage for patients.
- Resolved billing inquiries and disputes in timely fashion.
- Investigated insurance claims denials and appeals.
Fraud Specialist
Capital One
07.2018 - 05.2019
- Reviewed reports and individual transactions which appeared suspicious to uncover possible fraudulent activity.
- Performed risk assessments to determine level of fraud risk and prioritize investigations.
- Evaluated customer data to identify and prevent fraudulent activities.
- Developed and implemented procedures to detect and prevent fraud.
- Worked with third-party vendors to access and analyze data and systems.
- Tracked fraud cases and monitored trends to develop strategies for prevention.
- Contacted customers directly to notify of fraudulent activity and minimize impacts.
- Excellent communication skills, both verbal and written.
- Passionate about learning and committed to continual improvement.
Education
High School Diploma -
Matoaca High School
Chesterfield, VA06.2013
Skills
- Applicant Engagement
- Documentation and Paperwork
- Telephone Etiquette
- Program Knowledge
- Data Entry
- De-Escalation Techniques
Timeline
Authorization Specialist
SafeRide Health
04.2021 - Current
Referral Specialist
Centene, Superior Health Services
08.2019 - 03.2021
Customer Service Representative
ANTHEM Health Services
08.2019 - 06.2020
Fraud Specialist
Capital One
07.2018 - 05.2019
High School Diploma -
Matoaca High School
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