FRANCISCA CLAYBORNE

• Supported daily clinic operations by preparing exam rooms, managing patient flow, and assisting providers during patient visits.
• Performed administrative duties including scheduling, check-in/out, documentation, and insurance verification.

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• Managed appointment scheduling and patient communications efficiently.
• Provided compassionate, patient-centered support, helping to create a positive and efficient care experience.
• Coordinated with nurses, medical assistants, and clinicians to optimize workflow and reduce wait times.
• Assisted healthcare providers in patient intake and documentation processes.

• Manage administrative operations including admissions, discharges, and transfers.
• Communicate with medical staff, patients, and families to ensure seamless coordination of care.
• Maintain organized medical records, physician orders, and scheduling systems.
• Assist with supply ordering, inventory management, and policy compliance.
• Utilize EHR systems to support efficient unit workflow.

• Investigated and responded to member complaints through written and oral communication.
• Maintained up-to-date knowledge of policies, procedures, and operational developments.
• Assessed complaint and appeal submissions to determine appropriate resolution processes.
• Participated in internal complaint review committees to improve member experience.
• Led cross-functional teams in implementing strategic initiatives that improved project outcomes.
• Analyzed client needs and developed tailored solutions to enhance operational efficiency.

• Delivered high-quality support by resolving member concerns with empathy and accuracy.
• Interpreted health and dental plan benefits and provided tailored guidance.
• Investigated and resolved concerns related to claims, access to care, or service quality.

• Managed inventory of supplies and equipment with established procedures.
• Scheduled events and monitored facility conditions.
• Enhanced community engagement by organizing inclusive recreational activities.
• Supported participants and ensured safe program participation.

• Evaluated, negotiated, and settled over 100 complex property and bodily injury claims.
• Reviewed medical bills, litigation demands, and negotiated settlements.
• Prepared files for suit on behalf of insured clients.

• Handled initial claims calls for auto and fire policies, delivering exceptional customer service.
• Verified policy information and ensured accurate documentation.
• Collected all required data to properly route claims to the correct departments.
• Analyzed initial loss reports to identify trends and discrepancies for accurate data entry.
• Collaborated with cross-functional teams to streamline reporting processes and enhance workflow efficiency.

• Analyzed and segmented 5,000+ accounts using Fusion CRM to identify ERP/ERM sales opportunities.
• Increased sales by recommending solutions and promoting additional products.
• Achieved monthly sales goals through strategic outreach.