Jonathan Simien

Assess where each claim account is within the workers' compensation claims adjudication process. Gather appropriate information needed to move each account along to the payment or denial status. For denial statuses, pending on the timing and reason for the denial, initiate the appeals/reconsideration process as to generate payment. Prioritize each account as it pertains to to follow-up procedures by dollar amount , insurance carrier, as well as by how much time that has already elapsed between claim filing and processing.

Review, analyze and process member and provider appeal and grievance requests in accordance to CMS guidelines.

Addressing customer service inquiries while providing solutions to various customer issues in accordance to company and CMS guidelines.

Making outbound calls to those individuals who expressed interest in furthering their education. Also conducted interviews with those prospects in an attempt to match those prospects with the appropriate academic program that best fit their long-term goals.

Calculating and collecting payments for medical services and procedures rendered by various in-area medical facilities/clinics.

Responsible for responding to as well as resolving customer service inquiries according to company, CMS, and federal government guidelines via phone, email, and in-person contact.