Jessica E. Smith-Clayton

• Analyzed consumer policies that were flagged for inaccuracies and processed corrections in a timely manner using all available tools and resources.
• Facilitated Special Enrollment Period changes in policies due to eligibility, coordination of benefits and adding and removing members due to adoption, birth, death and change in circumstances.
• Termination of policies identified as fraud, waste and abuse. Adhered to HIPAA while protecting minimal PHI discloser.
• Proficiency in CEMB is based on a production environment. Accurately followed all DTP’s and SOP's to ensure the desired resolution of all assigned cases.
• Researched and resolved billing discrepancies to enable accurate billing.

• Assisted Medicaid members with all inquiries regarding their health plan benefits for medical, vision, dental and behavioral health.
• Verification of Prior Authorization status and eligibility for advanced imaging, chemotherapy, surgery as well as other medical procedures.
• Located in network specialist, laboratories, and updated members primary care providers
• Consistently met or exceeded performance metrics through proactive management of workload and effective prioritization.
• Facilitated denied claim inquiries and resubmission to claims reconsideration when appropriate
• Followed all HIPPA, state and federal guidelines
• Durable Medical Equipment orders

While being my grandfather's caretaker, I ensured that his daily needs were met. This included medication administration, meeting his nutritional requirements, daily chores. Most importantly being there for him in his greatest time of need.

• Maintained a database that identified customers eligible who were eligible to upgrade equipment
• Outbound calls to build rapport with current and new customers and made recommendations on new equipment based on their wants and needs
• Traveled to several franchise locations throughout Oklahoma for sales support and inventory management
• Navigated complex software systems efficiently, gathering essential data for accurate case management.
• Exceeded key performance indicators consistently by maintaining a strong focus on delivering exceptional customer experiences.

• Supported doctors with medical history reports, vitals and tissue sample collection for lab testing and medical diagnosis
• Surgery preparation, anesthesia monitoring and post op recovery
• Built lasting bonds with clients that would enable customers to trust staff

• Supported a team of two hundred financial service representatives with questions and concerns that would determine a plan of action for resolving past due balances.
• Assumed responsibility of a call when needed to assist in de-escalating upset customers that request to speak to a manager.
• Maintained a predictive dialer to control call volume and assist in keeping average wait time and hold time low.