Jasmine Owens
Spring,TX
Summary
Detail-oriented appeals and grievance claims specialist with 10 years of experience in healthcare administration. Skilled in reviewing and processing claims appeals, ensuring compliance with regulatory guidelines, and effectively communicating with providers and members. Proven track record in analyzing complex documentation, identifying discrepancies, and facilitating resolutions to enhance customer satisfaction. Adept at managing multiple cases simultaneously while maintaining a high level of accuracy and attention to detail. Committed to advocating for members’ rights and improving claims processes
Overview
11
11
years of professional experience
Work History
Appeals and Grievances Coordinator
Centene
12.2022 - 05.2024
- Processed and finalized appeals and grievances within agreed-upon turnaround time.
- Remained knowledgeable regarding company policies and procedures and current developments within operational departments.
- Submitted verbal and written notification to members and providers.
- Maintained strict confidentiality of sensitive member information while adhering to HIPAA regulations during case investigations.
- Demonstrated high-level attention to detail when reviewing medical records, provider contracts, and other relevant documents during case assessments.
Care Senior Associate Rep
Cigna
03.2017 - 09.2020
- Educated customers about the additional benefits available to them
- Reviewed programs designed to help them maximize these benefits
- My role involved managing inbound calls, scheduling future appointments, and, once I consistently met performance goals, assisting with other projects, including making outbound calls to offer additional programs
- Key skills utilized included typing, effective communication through inbound and outbound calls, multitasking with various applications, and scheduling appointments using Outlook.
Customer Service Representative
UnitedHealth Group
08.2015 - 08.2016
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- handled inbound calls from providers seeking information regarding patients’ medical benefits
- Assisted them in obtaining accurate and comprehensive benefit details, ensuring exceptional customer service
- facilitated the setup of prior authorizations and referrals for doctor appointments and scheduled surgeries
- Additionally, I quoted patients' medical benefits and reviewed medical claims with providers, advising them on the rationale behind claim payments or denials and outlining the steps needed to resolve denied claims
Pharmacy Technician
Walgreen's Pharmacy
03.2015 - 07.2015
- Answered incoming phone calls and addressed questions from customers and healthcare providers.
- Stocked, labeled, and inventoried medication to keep accurate records.
- Enhanced pharmacy workflow by assisting pharmacists with medication dispensing, labeling, and packaging.
- Calculated dosage, filled prescriptions, and prepared prescription labels with absolute accuracy.
- Promoted patient confidentiality by adhering to HIPAA regulations when handling personal information during transactions.
- Entered and processed patients' prescriptions into internal system.
- Consulted with insurance company representatives to complete claims processing, resolve concerns, and reconcile payments.
Customer Service Representative
Humana
08.2013 - 03.2015
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Handled inbound calls from members inquiring about drug coverage and benefits.
- Provided accurate copay information and confirmed prescription coverage.
- Informed members of in-network pharmacies and doctors' offices.
- Assisted in setting up payment arrangements and processing payments.
- Submitted authorizations for prescriptions, ensuring timely and accurate handling of requests.
Education
High School Diploma -
McClure South Berkeley High School
St Louis, MO05.2009
Skills
- Customer Service Excellence
- Effective Communication
- Multitasking Abilities
- Data Entry and Management
- Insurance and Benefits Knowledge
- Claims Processing
- Prescription Processing
- Financial Transactions Management
- Problem Solving
- Attention to Detail
- Time Management
- Appointment Scheduling
- Technical Proficiency (eg, Microsoft Outlook, POS Systems)
- Document Review and Analysis
- Collaboration with Healthcare Providers
Timeline
Appeals and Grievances Coordinator
Centene
12.2022 - 05.2024
Care Senior Associate Rep
Cigna
03.2017 - 09.2020
Customer Service Representative
UnitedHealth Group
08.2015 - 08.2016
Pharmacy Technician
Walgreen's Pharmacy
03.2015 - 07.2015
Customer Service Representative
Humana
08.2013 - 03.2015
High School Diploma -
McClure South Berkeley High School