Diera Cyntje

*Take Inbound calls assisting members with their questions and concerns

*Keep customer interactions recording details, inquires, complaints or comments, as well as actions taken

*Educate customers about healthcare topics

*Assist members with claims and benefits inquiries

*Assists members with navigating UHC websites

*Research complex issues on multiple databases/ Resolution through support resources

*Adhere to Compliance guidelines

*Document, filed and reviewed Appeals/ Grievances

*Review, route claims for accuracy and corrections

*Responded to Inquiries over the phone or written correspondence regarding claims eligibility

*Provider Outreach, Appeals and Grievances.

*Received Inbound calls and assisted members with billing questions.

·Handled Inquiries and complaints.

·Quote benefits, allowed amounts and premium payments

·Advised member of claims status.

·Created discrepancies into Footnotes Case System for Claims reprocessing.

·Researched and explained payment retractions and manual reduction

·Appeals tracking and forwarding

·Followed up with Members-Providers, advised of outcome of reprocessed claims