Jeffrey Kipe
Valrico
Summary
Skilled Benefits Verification Specialist and a proud US Navy Veteran with a significant background in healthcare and insurance industries. Four plus years of significant experience with Medicare where I resolved complex issues that required a significant amount of research and a lot of probing questions. I went through multiple training classes to get certification in multiple department that made me an expert in my field. I also have 1 1/2 years of experience with the Marketplace. Strong communication skills coupled with adeptness at using software tools for record-keeping and reporting. Previous work shows tangible impact through improved patient experiences and streamlining of benefits verification processes. I also have a proven track record of providing valuable insights, guidance, and solutions to complex problems. Strong analytical and communication skills, with a passion for sharing expertise and driving excellence in the field.
Overview
12
12
years of professional experience
Work History
CW Case Manager
Amgen
12.2024 - Current
- Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
- Conducted thorough assessments of clients'' situations, identifying issues, goals, and necessary interventions.
- Worked Missing Information Cases.
- Provided Portal Support for Doctor's and Site's.
- Resolved complex issues when it came to communication with the doctor's office. Like they didn't get the fax or they are not able to locate the patient on the portal.
CW Benefits Verification Specialist
Amgen
10.2022 - 12.2024
- Provided training sessions for new employees as a SME.
- Reviewed and verified eligibility of patients for benefits coverage.
- Provided detailed information about insurance plans and benefits to health care providers, patients, and staff members.
- Responded promptly and accurately to inquiries from patients, healthcare providers, and insurance companies via phone or email.
- Initiated contact with insurance companies as necessary to obtain additional information needed for verification purposes.
- Adhered to HIPAA regulations when handling confidential patient information.
- Attended training sessions on new policies or procedures related to benefit verifications.
- Conducted quality assurance checks on completed work prior to submitting it back out.
- Managed daily workloads while meeting deadlines set by management.
DME Tier 2 Claims Representative
Maximus Federal Services
10.2015 - 05.2022
- Conducted research into medical terminology related to healthcare claims processing activities.
- Documented changes in claim statuses using specialized software systems.
- Provided clear explanations of benefits, eligibility requirements, and applicable laws when communicating with customers.
- Educated customers on their rights under state and federal regulations governing insurance policies.
- Adhered to strict guidelines pertaining to confidentiality while handling sensitive personal information.
- Handled customer inquiries regarding insurance policy coverage details and payment status updates.
- Processed a high volume of claims efficiently while maintaining quality standards.
- Identified potential fraud indicators during the review process and reported suspicious activity accordingly.
- Maintained detailed records of all communication with customers, claimants, providers, and internal departments.
- Provided quality customer service to assigned, insured and claimants throughout claims process to deliver timely service to customers.
- Reviewed documentation and accounts to gain full picture.
- Interpreted and applied insurance policy provisions to determine coverage for each claim.
- Conducted training sessions for new hires on claims processing procedures and best practices.
Customer Service Representative
Intermedia Marketing Solutions
02.2013 - 09.2015
- Answered customer inquiries and provided accurate information regarding products and services.
- Provided excellent customer service to resolve customer complaints in a timely manner.
- Assisted customers with product selection, ordering, billing, returns, exchanges and technical support.
- Maintained detailed records of customer interactions, transactions and comments for future reference.
- Resolved complex problems by working with other departments to provide solutions that meet customer needs.
- Developed strong relationships with customers by providing personalized assistance and support.
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
- Answered incoming calls and emails, providing frontline customer support or assistance with product and service transactions.
- Remained calm and professional in stressful circumstances and effectively diffused tense situations.
Education
High School Diploma -
Frostproof Jr. Sr. High
06-1994
Skills
- Healthcare regulations
- Accuracy and Precision
- Insurance knowledge
- Proficient in [Software]
- Special projects
- Highly skilled in [Software]
- Problem-solving
- Case management
- Case documentation
- Documentation and reporting
- Email and telephone etiquette
Education and Training
other
Timeline
CW Case Manager
Amgen
12.2024 - Current
CW Benefits Verification Specialist
Amgen
10.2022 - 12.2024
DME Tier 2 Claims Representative
Maximus Federal Services
10.2015 - 05.2022
Customer Service Representative
Intermedia Marketing Solutions
02.2013 - 09.2015
High School Diploma -
Frostproof Jr. Sr. High
Similar Profiles
Cameron WilliamsCameron Williams
Data Scientist at AmgenData Scientist at Amgen
Oluwatola AkinmoladunOluwatola Akinmoladun
SOC Analyst at AmgenSOC Analyst at Amgen
RISHIKA RANGURISHIKA RANGU
Associate Data Engineer (Level - 3) at AmgenAssociate Data Engineer (Level - 3) at Amgen
Sarah BlackSarah Black
Manufacturing Associate at AmgenManufacturing Associate at Amgen
ERICK MARTÍNEZERICK MARTÍNEZ
Supervisor at S & K MechanicalSupervisor at S & K Mechanical