Fualili Paialii

• Assist in all inbound provider inquiries such as claims, credentialing status, appeals and benefits
• Review policies and other documents, and provide guidance to ensure claims are submitted in the proper manner to help ensure prompt and efficient processing
• Optimized claim submission processes by providing targeted guidance, resulting in faster processing times and improved provider satisfaction
• Meticulously researched complex claims using multiple systems, ensuring accurate status updates and resolving discrepancies efficiently
• Empowered providers with comprehensive claim status information, facilitating smoother communication and reducing follow-up inquiries
• Developed streamlined approach to policy review, enhancing claim submission accuracy and reducing processing delays for providers
• Streamlined claim research using QNXT, Propat, EDI, enhancing accuracy and efficiency in provider inquiries and complex claim resolution

• Resolve customer inquiries on first call, ensuring accurate assistance identification
• Guide customers through benefit plan options, maximizing their health plan value
• Assist users in navigating UnitedHealth Group websites, promoting self-sufficiency
• Improved first-call resolution rate, enhancing customer satisfaction
• Utilize detailed knowledge of benefits and claims to provide effective solutions
• Streamlined customer inquiry process, boosting first-call resolution rates and enhancing overall satisfaction with UnitedHealth Group services
• Empowered customers to maximize health plan value by providing expert guidance on benefit options and promoting self-service through website navigation
• Leveraged comprehensive knowledge of benefits and claims to deliver tailored solutions, significantly reducing follow-up inquiries

• Conduct thorough investigations and analyses of suspicious transactions and activities to identify potential money laundering or terrorist financing.
• Monitor and review transactions using AML software and tools, ensuring compliance with regulatory requirements and internal policies.
• Prepare detailed reports on findings and communicate them to management and relevant authorities as needed.
• Collaborate with law enforcement and regulatory agencies during investigations.
• Assist in the development and enhancement of AML policies, procedures, and training programs for staff.
• Stay updated on industry trends, regulatory changes, and emerging risks related to money laundering and financial crime.