Lisa Regusters
Brooksville,FL
Summary
Healthcare professional with proven success in delivering compassionate support and advocacy for patients and families. Strong focus on team collaboration and adaptability, ensuring seamless service delivery. Skilled in communication, conflict resolution, and resource coordination. Reliable and results-driven, consistently meeting changing needs of clients and colleagues.
History of enhancing claims processes and delivering high-quality support. Recognized for strong analytical skills and ability to adapt to dynamic work environments.
Overview
9
9
years of professional experience
Work History
Care Advocate II
Accolade Inc
03.2021 - Current
- Researched issues and took appropriate action to resolve issues within turnaround time requirements and quality standards.
- Contacted third-party payors to obtain and confirm authorization for services and communicated necessary related clinical information.
- Streamlined communication between patients, families, and healthcare providers, ensuring timely updates and accurate information sharing.
- Empowered members by providing education on navigating the healthcare system, enabling them to make informed decisions.
- Provided empathetic support to patients during challenging times, fostering trust and strong rapport.
- Improved patient satisfaction with tailored support and resources based on individual needs.
- Educated patients about available resources, enabling informed decision-making regarding their care options.
- Advocated for patients'' rights, ensuring access to appropriate services and fair treatment within the healthcare system.
- Worked with enrollees to identify gaps in care or obstacles to care.
- Stayed calm under pressure to and successfully dealt with difficult situations.
- Answered incoming calls, outbound calls, scheduled appointments and documented records.
- Followed document protocols to safeguard confidentiality of patient records.
- Engaged with patients to provide critical information.
- Applied administrative knowledge and courtesy to explain procedures and services to patients.
- Helped resolve client complaints through timely corrective actions and using established follow-up procedures.
- Offered simple, clear explanations to help clients and families understand hospital policies and procedures.
Account Executive
Careers USA
03.2019 - 12.2019
- Boosted and enhanced client satisfaction by maintaining strong relationships through effective communication, thorough needs assessments and delivering tailored solutions.
- Managed multiple accounts simultaneously while maintaining organization and prioritizing tasks efficiently.
- Conducted regular check-ins with existing clients to assess their needs and identify upselling opportunities.
- Assisted in the onboarding process for new clients, ensuring a smooth transition
- Participated actively in networking events, representing the company professionally and expanding its reach within target markets.
- Managed client portfolios to enhance overall satisfaction.
- Provided exceptional customer service, addressing client concerns promptly and effectively to ensure long-term loyalty.
- Streamlined internal processes for customer relationship management, significantly reducing response times to client inquiries.
- Enhanced team performance, sharing best practices; mentoring and training junior account executives.
- Fostered long-lasting relationships with major clients to secure repeat business and referrals.
- Identified new business opportunities through cold calling, networking, marketing and prospective database leads.
- Met with customers to discuss and ascertain needs, tailor solutions and close deals.
- Built relationships with customers and community to promote long term business growth.
- Demonstrated compelling, persuasive and composed professional demeanor.
- Contributed to team objectives in fast-paced environment.
- Fielded customer complaints, resolving issues and reaching mutual conclusions.
- Served customers with knowledgeable, friendly support at every stage.
- Greeted customers and offered assistance with selecting new hires, interviews and job placement.
Claims Support Specialist
Capgemini
09.2015 - 10.2018
- Provided backup support to claims adjusters during high volume periods, ensuring smooth processing and timely resolution of cases.
- Collaborated with cross-functional teams to optimize the overall claims management process, resulting in improved workflows.
- Enhanced customer satisfaction with timely communication on claim status updates and followups. Communicated with clients, distributing mail, and scanning documents.
- Conducted thorough research on claimant backgrounds, validating information accuracy before proceeding with case evaluations.
- Managed claims-related correspondence efficiently, ensuring timely responses to queries or requests. Coordinating with adjusters, appraisers, and other team members.
- Organized and maintained electronic claim files, enabling easy access to records for future reference or audits.
- Identified potential fraud cases through detailed analysis of claim documents and patterns, referring suspicious cases for further investigation.
- Performed regular quality checks on processed claims data to ensure integrity of information entered into the system is maintained.
- Facilitated positive client relationships by addressing inquiries promptly and professionally via phone or email correspondence.
- Contributed to training initiatives for new hires, sharing knowledge on best practices in claims support functions.
- Assisted in optimizing existing processes through continuous improvement efforts, resulting in increased operational efficiencies.
- Handled escalated issues from clients regarding their claims process, working collaboratively with relevant parties to resolve concerns quickly.
- Supported management in reporting tasks by providing relevant data analysis and insights on departmental performance metrics.
- Provided comprehensive administrative support to the Claims Department, ensuring efficient daily operations and smooth case handling.
- Maintained compliance with industry regulations and company policies while processing claims information.
- Evaluated and settled complex insurance claims in strict timeframes.
- Followed up with customers on unresolved issues.
- Checked documentation for accuracy and validity on updated systems, verifying client information. Posting and attaching information to claim files.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Prepared insurance claim forms or related documents and reviewed for completeness.
- Maintained confidentiality of patient finances, records, and health statuses.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Communicated effectively with staff members of operations, finance and clinical departments.
- Reviewed outstanding requests and redirected workloads to complete projects on time.
- Determined appropriateness of payers to protect organization and minimize risk.
Education
High School Diploma -
Cardinal Dougherty High School
Philadelphia, PA 06-2001
Skills
- Professional boundaries
- Self-awareness
- Healthcare
- Cultural history
- Customer service
- Problem-solving
- Multitasking and organization
- HIPAA compliance
- Customer follow-up
- Verbal and written communication
- Patient education
- Phone and email etiquette
- Data entry
- Conflict resolution
- Policy understanding
- Records maintenance
- Teamwork and collaboration
- Time management
- Active listening
- Documenting and recording information
- Communicating to patients and families
- Microsoft office
- Claims analysis
- Claims processing
- Computer proficiency
- Insurance claim forms review
- Client relationship building
Timeline
Care Advocate II
Accolade Inc
03.2021 - Current
Account Executive
Careers USA
03.2019 - 12.2019
Claims Support Specialist
Capgemini
09.2015 - 10.2018
High School Diploma -
Cardinal Dougherty High School
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