Erin Cates
Highland
Summary
Experienced in efficiently managing multiple issue resolution processes, utilizing strong analytical skills and effective communication to resolve complex cases. Possesses knowledge of regulatory standards and compliance, ensuring smooth operations and client satisfaction.
Overview
11
11
years of professional experience
Work History
Senior Appeals Representative
UnitedHealthcare
08.2023 - 05.2025
- Review and evaluate member and provider appeal submissions per appeals guidelines
- Review reimbursement policies to ensure denial accuracy
- Redirect appropriate case issues to internal partners for review
- Create and review appeal correspondence to members and providers
- Perform new case triage and key to appeals system
- Review incoming appeal cases for trends
Subject Matter Expert/Escalation Representative
UnitedHealthcare
08.2021 - 08.2023
- Provide expert guidance and advice regarding benefits and claim processing
- Conduct training and coaching to individual agents and in group setting regarding claim processing and benefit review
- Handle escalated telephone calls from members and providers
- Apply appropriate communication techniques when responding to customers, particularly in stressful situations
- Partner with internal and external departments to ensure timely resolution
- Ensure quality customer service for internal and external customers
Empire Issue Resolution Specialist
UnitedHealthcare
10.2016 - 08.2021
- Perform outreach to providers to resolve member claims and benefits commitment issues
- Solve problems systematically, using sound business judgement
- Maintain timely and accurate documentation for all customer service needs
- Monitor delegated customer services issues to ensure timely and accurate resolution
Empire Health Advisor
UnitedHealthcare
09.2014 - 10.2016
- Identify and assess customers’ needs quickly and accurately
- Resolve problem systematically, using sound business judgement
- Apply appropriate communication techniques when responding to customers, particularly in stressful situations
Education
B.A. - Business Administration/Healthcare Administration
American InterContinental University
Chicago, IL09.2015
Skills
- Microsoft office
- Policy interpretation
- Dispute resolution
- Teamwork
- Time management
- Multitasking skills
- Attention to detail
- Problem-solving
- Critical thinking
- Excellent communication
- Decision-making
Timeline
Senior Appeals Representative
UnitedHealthcare
08.2023 - 05.2025
Subject Matter Expert/Escalation Representative
UnitedHealthcare
08.2021 - 08.2023
Empire Issue Resolution Specialist
UnitedHealthcare
10.2016 - 08.2021
Empire Health Advisor
UnitedHealthcare
09.2014 - 10.2016
B.A. - Business Administration/Healthcare Administration
American InterContinental University
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