Jasper Arroyo

• Handled escalated calls efficiently, finding satisfactory resolutions for both members and the company alike.
• Resolved members escalated complaints with empathy, resulting in increased loyalty and repeat business.
• Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.

• Reduced errors in claim submissions by providing clear guidance to Providers on required documentation and information needed for processing.
• Ensured accurate documentation and record-keeping, adhering to company policies and CMS regulations.
• Enhanced customer satisfaction by efficiently resolving claims and addressing policyholder concerns.

• Conducted thorough investigations for complex cases, ensuring fair and accurate outcomes.
• Resolved members complaints with empathy, resulting in increased loyalty and repeat business.
• Ensured compliance with HIPAA regulations when handling sensitive member information, protecting member privacy at all times.

• Conducted comprehensive investigations on complex cases, leading to successful outcomes and satisfied members.
• Enhanced members confidence in the grievance process through clear communication and empathetic handling of sensitive issues.

-Manages the investigation and resolution of medical and/or dental appeals in compliance with CMS regulatory requirements and company policies.

-Conducts thorough investigations to complete comprehensive reviews, often collaborating with internal departments to gather necessary information.

-Maintains precise documentation of all activities, decisions, and correspondence in the system.