Jessica Daniel

• Responded to external audits by providing requested claims documentation and explanations.
• Assisted new policyholders with processing claims.
• Applied knowledge of coding systems such as CPT-4 and HCPCS codes for proper reimbursement.
• Analyzed contracts and claim systems to apply appropriate benefit amounts.
• Identified and flagged suspicious claims for further investigation.
• Processed a high volume of incoming claims in accordance with established policies and procedures.
• Utilized claims processing software to streamline workflow and increase efficiency.

• Review claims to assure claims processing correctly
• Call over to same day adjust team if claims are incorrectly processed
• Review benefits and advise both members and provider of benefits allowed
• Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
• Answered inbound calls, chats and emails to facilitate customer service.
• Demonstrated excellent communication skills in resolving product and consumer complaints.
• De-escalated problematic customer concerns, maintaining calm, friendly demeanor.
• Consulted with customers to resolve service and billing issues.
• Escalated customer concerns, issues and requirements to supervisors for immediate rectification.
• Upheld quality control policies and procedures to increase customer satisfaction.
• Fielded customer complaints and queries, fast-tracking for problem resolution.

• Investigated insurance policies to determine claim eligibility and processed files in accordance with instructions.

• Maintained confidential patient documentation to prevent data compromise and comply with HIPAA regulations.

• Setting up ACH draftings
• Customer Service
• Called responsible party regarding past due payments
• Worked Followups for problem accounts
• Update payment method on accounts
• Worked on-line change request from the Dental offices
• Worked Help Requests from responsible parties to update payment method or postpone payments
• Activate accounts in Any doc for draftings to begin
• Answer inbound calls

• Screen applications for Intake
• Entered Applications in TCSES
• Second day clean up on application
• Interviews with walk-in clients
• Contact noncustodial and custodial parents for phone Interviews
• Confirm all information provided using online sources
• Answered and logged incoming inquiries via phone, fax and email.
• Issued, gathered and inspected intake forms to confirm correct signatures and information.