Diamond Davis

FULL-TIME, 40 HRS PER WEEK

• The Program Support Assistant maintains control of 1358 obligations by calculating estimated costs per authorization/episode of care based on monthly reports provided by Non-VA Care Supervisor and ensures that all assigned fund control point activities and transactions are posted on a regular basis.
• Audits fee service invoices for accuracy and rejects or denies non-allowable items.
• Coordinates payment of per diem charges and medications for admissions to Contract Nursing Homes.
• Requests updated veteran information, including eligibility verification through the HINQ database, VA Form 10-7131 from the VA Regional Office and / or by telephone and written correspondence.
• Communicate with veterans, veterans' family, veterans' represen1atives, and physicians including those within the private sector and those within the VA.
• Reviews incoming mail and appropriately distinguishes which Fee Program claims are associated with, verify and distribute claims in FBCS as well as approves payment and/ or denies those veterans' claims found ineligible.
• Prepares authorizations for appropriate validity periods and mail or fax to vendors and veterans.

FULL-TIME, 40 HRS PER WEEK

• Conduct every transaction with a customer focused, courteous, approach that will ensure the best possible outcome along with exceptional satisfaction scores
• A strong desire to learn and grow
• Ability to be punctual, build rapport quickly, and exceed goals
• Listen and respond appropriately in all customer interactions by researching, problem solving and resolving customer issues with a high degree of accuracy
• Demonstrate effective verbal communication skills
• Document all activity into clients' systems
• Maintain a working knowledge of applicable regulations and standards
• Maintains access for all client systems, as assigned
• Acts as an effective team member
• Other duties as assigned.

FULL-TIME, 40 HRS PER WEEK

• The Workforce Management Real-time Analyst (WFM RTA) is responsible for effectively managing call volume routing, representative statuses, making real time staffing and routing adjustments to meet volume requirements, adherence metrics that meets or exceeds key performance indicators for service level and first call resolution on each program
• Monitor intraday performance, notifying managers and supervisors as problems arise in order to optimize service level
• Work with supervisory team and WFM Manager to adjust call center scheduling, staffing to meet both intraday and future needs
• Monitor staff adherence to work schedules and provide adherence reports to business unit leadership
• Develops and maintains relationships with the center's Leadership and its management teams
• Collaborates and partners with the WFM Manager and WFM Analysts
• Research required information and resolve Workforce Management inquiries using available resources
• Update and provide hourly attendance and program KPI updates
• Innovate process enhancements for improved efficiency
• Regularly communicate with Operations leaders and representatives on ACD/IVR Statuses
• Review, work, and resolve WFM tickets, including schedule adjustments
• Other duties as assigned.

FULL-TIME, 40 HRS PER WEEK

• Review Claims, adjustments, and claims related processes for accuracy -The Quality Review Database and a variety of other reports are utilized
• Review Phone Calls - Calls are reviewed from InContact
• Compile, analyze and communicate department quality summaries (findings and trends) to department manager(s) and lead(s)
• Partner with Claim's Managers', Leads and Training to identify areas of opportunity for training, job aids, documentation updates and system enhancements
• Continuously look for ways to improve and enhance our quality program to ensure quality excellence
• Prepare for and facilitate department error remediation meetings
• Process claims, adjustments and/or other claims related activities to stay current on system processing and procedures and documentation.

FULL-TIME, 40 HRS PER WEEK

• Responsible for interpreting claim adjudication rules to process and/or adjust simple claims
• Daily accountability for meeting production and quality standards by performing the following
• Analyze claims for accuracy and completeness to determine benefits based on specific member and provider contracts, payment rules, eligibility status, COB requirements and provider status in a timely manner
• Efficiently use multiple systems and screens to obtain and record claim information
• Follow all relevant policies and procedures
• Review medical record documentation, authorization information and member benefit coverage to determine the extent of liability for payment
• Process claims within quality and production standards
• Take determinations on the appropriate adjudication of claims with the assistance of leads or other more experienced examiners
• Approaching and progressing towards a Claims Examiner II skillset
• Identify areas of concern that may compromise member, provider and group satisfaction
• Identify claims that suggest a potential issue or problem with the claim system configuration or provider contract configuration
• Communicate any issues as appropriate for research and correction.

FULL-TIME, 40 HRS PER WEEK

• Responsible for interpreting claim adjudication rules to process and/or adjust simple claims
• Daily accountability for meeting production and quality standards by performing the following: Analyze claims for accuracy and completeness to determine benefits based on specific member and provider contracts, payment rules, eligibility status, COB requirements and provider status in a timely manner
• Efficiently use multiple systems and screens to obtain and record claim information
• Follow all relevant policies and procedures
• Review medical record documentation, authorization information and member benefit coverage to determine the extent of liability for payment
• Process claims within quality and production standards
• Take determinations on the appropriate adjudication of claims with the assistance of leads or other more experienced examiners
• Approaching and progressing towards a Claims Examiner II skillset
• Identify areas of concern that may compromise member, provider and group satisfaction
• Identify claims that suggest a potential issue or problem with the claim system configuration or provider contract configuration
• Communicate any issues as appropriate for research and correction.

FULL-TIME, 40 HRS PER WEEK

• Communication with other areas of underwriting, sales and special investigations may also be necessary
• The claims must be managed while ensuring customer satisfaction
• Determine eligibility based on contract language, payroll records, and other supporting documentation
• Determine financial liability based on salary, other income sources and contract language
• Approve initial payment and determine qualification of continuing payments
• Adhere to ERISA and other federal/state law concerning group disability insurance
• Demonstrates flexibility and ability to support unique customer requirements
• Creates written letters to the claimant for the purpose of providing concise explanations for claims determinations
• Actively engages in lean process design by participating in the identification and elimination of nonvalue add activity
• This position requires extensive or prolonged typing/keyboarding.

FULL-TIME, 40 HRS PER WEEK

• Track and verify that Bank of the West has a secured lien on direct loans, including home equity loans and lines of credit and also all other consumer products, including Auto, RV, and Marine loans
• Analyze and review documentation to ensure that the securing documents reflect accurate information
• Process incoming requests and title maintenance transactions
• Review, log, and submit incoming titles to local vault or Third party title Management Company for safekeeping
• Perform all maintenance on above referenced collateral, including title updates and changes and partial releases
• Audit incoming mail to help organize and divide work appropriately.