Summary
Work History
Skills
Timeline
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Janice Tesch

Healthcare Claims Customer Service
Green Bay,Wisconsin

Summary

PERSONAL PROFILE: Skilled and experienced in the Health Insurance field, with over 10 years of experience working from home. Experience in adjusting claims, claims quality auditing and processing Medicare appeals, as well as working in a call center. Have the proven ability to learn new health care systems and processes and adapt to changing environments while working remotely. Have excellent time management skills and deliver quality results, on time, while exceeding performance and quality metrics. Resolves problems quickly and delivers high level of customer satisfaction in a work at home capacity.

Work History

Appeals Resolution Analyst

UnitedHealth Group
Green Bay, Wisconsin
2017 - 2021
  • DSNP Appeals – Remote – Work From Home.
  • Verify all required documentation is included with appeal per written guidelines.
  • Extensively research appeals and use all available resources to determine if health care appeal should be upheld, overturned or changed to an inquiry.
  • Submit claims for processing for all overturned appeals.
  • Perform closure and effectuation for appeals when health care claims have been paid.
  • Send letters to members and providers to inform them of the appeal decision.
  • Responded to support requests from members and providers and patiently walked individuals through steps needed to complete appeals.

Claims Quality Audit Representative

UnitedHealth Group
Green Bay, Wisconsin
2016 - 2017
  • Remote – Work from Home.
  • Research physician and in-patient claims to ensure that each claim was processed correctly, including approval and denial of medical services and correct payment.
  • Analyzed quality defect trends and provided feedback reports to claims processors to reduce future errors and improve the claims processing system.
  • Update SOPs to clarify claim processing rules.
  • Maintain/exceed quality and production metrics.

Claims Adjustment Representative

UnitedHealth Group
Green Bay, Wisconsin
2013 - 2016
  • SAM Edit Team – Remote – Work from Home.
  • Process complex physician and in-patient claims according to a set of claim processing rules and adjust claims as necessary.
  • Research medical plans to determine insurance coverage.
  • Evaluate claims database to process claim.
  • Maintain insurance information in UNET claims system.

Senior Customer Service Representative

UnitedHealth Group Optum
Green Bay, Wisconsin
2010 - 2013
  • Remote – Work from Home.
  • Answer approximately 80 – 100 phone calls per day in the call center, while continuously providing world class customer service to each and every caller.
  • Follow all HIPAA regulations regarding both written and verbal communication, to prevent any inappropriate release of personal health information.
  • Ensure that proper ICD-10 codes are assigned to each file.
  • Served as a Team Leader for Injury Questionnaire processing.
  • Evaluated customer information to explore issues, develop potential solutions and maintain high-quality service.

Office Manager

St. Norbert College
De Pere, Wisconsin
2000 - 2010
  • Supervised a staff of from 3 to 5 student workers, as well as 2 other clerical staff workers.
  • Create and maintain schedules for each professor that provide at-a-glance information which was necessary for students, professors and staff.
  • Develop and update new system to track student advisor changes, ensuring that information was immediately available to professors and students.
  • Research and purchase office supplies, textbooks and software, saving the department a significant amount of money.
  • Gather and analyze admission data and create trend reports that were used by both the Admission and Marketing Departments.
  • Monitored and evaluated personnel performance to complete annual reviews, recommend advancement or address productivity concerns.

Skills

Healthcare Claims Adjusting

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Timeline

Office Manager

St. Norbert College
2000 - 2010

Senior Customer Service Representative

UnitedHealth Group Optum
2010 - 2013

Claims Adjustment Representative

UnitedHealth Group
2013 - 2016

Claims Quality Audit Representative

UnitedHealth Group
2016 - 2017

Appeals Resolution Analyst

UnitedHealth Group
2017 - 2021

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Janice TeschHealthcare Claims Customer Service