Janae Tuck
Oakland,CA
Summary
Dynamic and results-oriented Claims Associate with over 10 years of comprehensive experience in claims processing, utilization management, and client relations within the healthcare and financial services sectors. Adept at navigating complex claims scenarios and implementing solutions that enhance operational efficiency and compliance. Exceptional analytical and communication skills enable effective collaboration with cross-functional teams to improve patient and member outcomes. Proficient in leveraging EHR systems such as Epic and Facets, as well as data analysis tools like SQL and Tableau. Dedicated to delivering outstanding customer service and driving continuous process improvements.
Overview
13
13
years of professional experience
Work History
Authorization Specialist
Blue Shield of California
Oakland , CA
10.2023 - 10.2024
- Process an average of 150 authorization requests weekly using Facets, ensuring compliance with insurance policies and reducing approval errors by 10%.
- Collaborate with healthcare providers to gather documentation, decreasing approval times by 15% and achieving a 98% on-time approval rate.
- Utilize Epic and other EHR systems to track authorizations, maintaining a 95% approval rate, and reducing patient treatment delays by 20%.
- Liaise between patients, providers, and insurance representatives, resolving 90% of inquiries within 24 hours, and increasing customer satisfaction scores by 15%.
- Monitor trends and implement process improvements, increasing team productivity by 12% and reducing rework by 8%.
- Train and mentor new team members, resulting in a 10% improvement in team efficiency within six months.
Customer Service Team Lead
Chevron Federal Credit Union
Concord, CA
10.2017 - 10.2023
- Supervise and mentor a team of customer service representatives, ensuring high-quality service delivery and compliance with company standards.
- Monitor team performance metrics and implement strategies to enhance efficiency and customer satisfaction.
- Handle escalated calls in a call center environment, resolving complex customer inquiries promptly and effectively.
- Conduct regular training sessions and performance reviews to enhance team skills and overall knowledge.
- Collaborate with cross-functional teams to improve processes and proactively address customer feedback.
- Analyze customer service trends and develop actionable plans to drive continuous improvement.
Account Executive
Fidelity Home Warranty
Concord , CA
01.2015 - 10.2017
- Managed a diverse portfolio of client accounts, overseeing the claims process to ensure client satisfaction throughout their insurance lifecycle.
- Conducted needs assessments and provided tailored solutions, improving client retention rates by 20%.
- Analyzed claims data to identify trends, resulting in a 30% reduction in processing turnaround times.
- Collaborated with cross-functional teams to address client inquiries and concerns, fostering positive relationships and enhancing service delivery.
- Delivered training sessions for clients on policy options and claims procedures, improving client understanding and satisfaction.
Patient Access Representative
O’Connor Hospital
San Jose, CA
01.2012 - 01.2015
- Managed daily admissions and discharges for over 50 patients, ensuring precise electronic health record (EHR) data entry and accurate medical billing processes using Epic.
- Achieved a 98% patient satisfaction score by delivering exceptional customer service, promptly addressing patient inquiries, and effectively resolving concerns to enhance the patient experience.
- Coordinated patient referrals with medical staff and specialists, enhancing follow-up care and continuity of care for patients.
- Established and implemented best practices for data management and patient confidentiality, ensuring compliance with HIPAA and other healthcare regulations, while boosting operational efficiency.
Education
Associate of Science - Behavioral Sciences
Chabot College
Hayward, CASkills
- Claims Management
- Customer Service Excellence
- Client Account Management
- Team Leadership
- Proficient Time Management
- Utilization Management
- Verbal and Written Communication
- SQL Proficiency
- Epic Systems Expertise
- Tableau Proficiency
Timeline
Authorization Specialist
Blue Shield of California
10.2023 - 10.2024
Customer Service Team Lead
Chevron Federal Credit Union
10.2017 - 10.2023
Account Executive
Fidelity Home Warranty
01.2015 - 10.2017
Patient Access Representative
O’Connor Hospital
01.2012 - 01.2015
Associate of Science - Behavioral Sciences
Chabot College