Frances Monteiro

• Performed research on questionable claims, handled internal and external correspondence and provided feedback of resolution to members, providers and internal departments.
• Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
• Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
• Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
• Responded to customer requests for products, services, and company information.

Identify, recruit, and mentor union members to participate in Union Partnership activities and ensure that the receive the appropriate training

• Support and participate in major partnership programs such as Unit Based Teams, Workplace Safety, Joint Staffing and Issue Resolution & Corrective Action on behalf of the Union
• Support and participate in special projects for work teams or departments
• Represent UFCW in partnership projects and organizational initiatives which are determined to be crucial to Labor interests
• Participate in additional activities which make a positive contribution in Union capacity to effectively engage in the Partnership.

• Audited benefit and coverage decisions, payment amounts, coding assignments, recoup over payments caused by incorrect coding
• Interact with other departments on policy and procedures, identify training needs as well as review and adjudicate claims over $300,000.
• Provided detailed documentation on audit findings, facilitating swift corrective action when necessary.
• Maintained confidentiality, handling sensitive information discreetly throughout all stages of the audit process.
• Ensured compliance with regulatory requirements by performing regular audits and staying up-to-date on industry standards.
• Followed established auditing processes to meet internal and regulatory requirements.
• Developed strong relationships with clients, building trust and ensuring a high level of satisfaction during the audit process.

• Participate in coalition of Kaiser Permanente unions efforts and keep national coalition of Kaiser Permanente Union staff informed
• Identify need for labor engagement in KP Health Connect activities and work with Unions to select and support sufficient labor representatives
• Keep institutional Unions informed of initiatives and engaged in addressing emerging issues, serving as their representative in day-to-day initiative activates and workflow
• Monitor KP Health Connect process and workflow experiments and pilots.

• Investigated and managed third party liability information, posted revenues returned and requested for over and incorrect payments
• Provided internal staff with weekly/monthly reports.
• Supported management in identifying opportunities for process improvement within the department's operations.

• Reviewed and processed complex claims, assisted with training of new staff and functioned as supervisor in the absence of the supervisor
• Reviewed, processed and performed data input of claims; resolved questionable payments.