Justin Huff

Work History

Shift Supervisor Trainee

CVS Pharmacy

10.2023 - Current

Actively assist store customers with general questions and resolve any complaints according to company policy.
Help to drive improved customer satisfaction with prompt and courteous service.
Supervise and coach store team members with various store activities.
Support store management in reducing inventory shrink through best practices.
Coordinate with other Shift Supervisors to ensure smooth operations across all shifts.
Collaborates with the management team to set targets and develop strategies for meeting store goals.
Ensured high-quality product presentation through proper merchandising techniques and adherence to company standards.

Rideshare Driver

Self-employed

05.2023 - 09.2023

Built and maintained positive relationships with passengers by providing friendly and professional service.
Developed strong communication skills while interacting with diverse groups of riders daily.
Assisted passengers with loading and unloading luggage for an enhanced customer experience.
Followed company guidelines and policies when interacting with passengers.

Grievance & Appeal Analyst

Elevance Health

09.2022 - 05.2023

Reviewed and responded to Medicaid member complaints related to medical and pharmacy claims, benefits, provider and health plan services.
Assisted members with locating specialty care providers and assist with scheduling appointments and follow up care.
Acted as a liaison between multiple internal departments to assist with resolution of member grievance and complaint within a timely manner.
Utilized Medicaid health plan guidelines and conducted extensive research to analyze the member's grievance issue as well as pertinent claims and medical records to either approve or summarize and route to staff for review.
Followed department guidelines and utilized company-provided tools to conduct grievance and complaint reviews following components of URAC and NCQA accreditation requirements.
Successfully analyzed and resolved more than 20 grievances and complaints per week as part of the individual and departmental goal.
Actively participated in monthly and quarterly outreach to health plan members, regarding assistance with the health plan as well as any required outreach as designated by Health and Human Services.

Claims Examiner

Health Special Risk, Inc.

03.2019 - 08.2022

Processed a different claims from simple, to complex to ongoing.
Examined claims forms and other records to determine insurance coverage.
Contacted providers and claimants to request necessary information to complete claim processing.
Verified insurance claim details and determined correct amounts for accurate and complete claim payment or denial.
Conducted day-to-day administrative tasks to maintain internal information files and process claims accurately.
Tracked claim issues thoroughly to completion and ensuring all follow up actions are complete timely and accurately.

Pharmacy Customer Care Representative II

Anthem, Inc.

06.2018 - 08.2018

Managed incoming calls and faxes for prior authorization requests for specific high-cost, high-touch medications.
Conducting thorough screening calls with healthcare professionals and members to obtain clinical information necessary to initiate mediation prior authorizations.
Followed strict state/federal legislation on administration and approval for certain medications, including Opioids.
Tracked progress of cases using internal software programs and databases.
Following up with the customer and provider, as necessary, for any denials or additional information requests for prior authorization approval.
Referring more complex cases involving medical review and clinical determination to a pharmacist for resolution.
Analyzed and identified pharmacy error trends and made recommendations for resolution during team huddles.

Claims Supervisor

UnitedHealthcare

03.2016 - 04.2017

Actively led a team of 15-20 individuals who processed medical claims.
Responsible for monthly coaching, development, and performance management for each claims representative.
Facilitated daily work direction and activities for the team.
Managed payroll, including time validation and approval.
Reviewed and ensured that agents adhered to work schedules.
Actively involved in monthly claims and correspondence inventory and capacity planning.
Worked with other business areas and leaders to coordinate business activities.

Senior Claims Trainer

UnitedHealthcare

10.2014 - 03.2016

Participated in the initial training and on boarding of new hires within the claim organization.
Used role playing, simulations, team exercises, group discussions, videos, and traditional facilitation to instruct trainees in a variety of ways.
Implemented a variety of assessment tools and strategies to improve instruction methods.
Assessed and identified individual training needs through reports, surveys, coaching with employees, focus groups and frequent consultation with leadership teams in both the claims and training organization.
Reviewed daily and weekly metrics of new hire claim processors to evaluate strengths and weaknesses and develop tailored action plans to successfully increase performance.
Monitored trainee attendance, workflow, and behaviors throughout the training process, providing corrective action, as necessary.
Planned and led UnitedHealth's initial claims training class on a new, accelerated claims training platform.

Subject Matter Expert

UnitedHealthcare

04.2013 - 10.2014

Functioned as the claim expert for answering inquiries about claim policies and procedures for claim adjustment specialists across the Nation.
Assisted as a team leader in facilitating team meetings, and providing metric reports to the supervisor on each team member.
Created and led weekly development workshop, providing training tips for the team to drive quality and productivity metric improvements.
Trained staff on claim processing updates or changes to procedures.
Coached claim adjustment specialists on errors and error trends to help improve quality scores and decrease defects on the team.
Participated in developing new workflows and testing business changes before they were rolled out across the claim organization.
Processed high dollar, dedicated customer and special situation claims not generally handled by claim adjustment specialists with a high level of accuracy and attention to detail.

Provider Claim Resolution Specialist

UnitedHealthcare

03.2010 - 04.2013

Processed a verity of simple, moderate, and complex medical, dental and vision claims.
Researched and resolved provider contracting issues, including, allowable amounts disputes, fee schedule verification and eligibility for certain submissions.
Provided provider education via telephone on appropriate claim, benefit and contract procedures.
Participated in company-wide Time Production studies to increase efficiencies and reduce defects in the claim process.
Processed dedicated customer claims with a high level of accuracy to maintain customer and client satisfaction.
Consistently exceeded claim production and quality metrics – including 12 continual months of perfect claim dollar and processing accuracy.
Provided coaching support for trainees transitioning from training to the production environment.

Summary

Overview

Work History

Shift Supervisor Trainee

Rideshare Driver

Grievance & Appeal Analyst

Claims Examiner

Pharmacy Customer Care Representative II

Claims Supervisor

Senior Claims Trainer

Subject Matter Expert

Provider Claim Resolution Specialist

Education

High School Diploma -

Skills

Software

Timeline

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