KAE JOSEPHS
United Healthcare
Hyde Park,NY
5
years of professional experience
Results-driven healthcare professional with 5 years of Empire Plan experience in provider and member support, claims research, and benefits administration. Skilled in utilizing UNET, NBD, and TOPS systems for accurate claims resolution and member account analysis. As an Escalation/Confer Representative, fosters strong provider relationships, effectively resolves complex issues, and enhances service delivery in a fast-paced environment.
Work History
Subject Matter Expert/Escalation Representative
8 Months- · Researched, processed, and coordinated claims adjustments, ensuring compliance with plan guidelines and quality standards to mitigate errors.
- · Utilize UNET, NBD, and TOPS to review member accounts, investigate claim discrepancies, and identify appropriate resolutions.
- Collaborated with claims, operations, and other business units to research and resolve service-related issues including HCAP claims.
- Provide real-time support and guidance to Health Advocates, ensuring accurate interpretation and consistent application of policies and procedures.
- Resolve high-level member and provider escalations by coordinating with internal departments and external providers to achieve timely, effective resolution.
Health Advisor/ Consumer Resolutions Advocate
4 Years 3 Months- Researched and coordinated claim adjustments on first contact using UNET, NDB, TOPS, ensuring compliance with plan guidelines and procedures.
- Built provider relationships by addressing concerns, explaining benefits and policies, and facilitating timely issue resolution.
- Handled 40+ daily inbound calls, providing clear and professional support.
- Provided information such as copay and premium details, pre-approval procedures and available products.
- Resolved problems related to benefits, eligibility and claims.
Education
Bachelor of Science - Health Care Management
Skills
· Claims adjustments
· Benefits administration
· Provider support
· Issue Resolution
· Team Collaboration
Claims Processing
· NBD
· Provider & Member Support
· Healthcare Benefits Administration
· Customer Service Leadership
· Cross-functional collaboration
Timeline
Subject Matter Expert/Escalation Representative
United Healthcare
02.2026 - CurrentRead More
Health Advisor/ Consumer Resolutions Advocate
United Health Care
11.2021 - 02.2026Read More
State University of New York
Bachelor of Science from Health Care Management
Read More