Katherine Lufkin

• Conduct thorough reviews and audits of insurance policies, claims, and documentation to ensure accuracy and compliance with regulatory requirements and company standards.
• Assisted in conducting quality assurance reviews of health insurance plans, ensuring adherence to company policies and regulatory standards.
• Analyze QA metrics and prepare detailed reports on findings, trends, and recommendations for management review.
• Facilitate training sessions and create documentation to enhance understanding of QA procedures and compliance standards.
• Collaborated with cross-functional teams across the organization to ensure adherence to quality objectives.
• Collaborated with management to discuss effective plans for resolving major quality problems.

• Maintained Providers satisfaction with forward-thinking strategies focused addressing provider needs and resolving concerns.
• Answered constant flow of customer calls with minimal wait time.
• Offered advice and assistance to providers, paying attention to special needs or wants.
• Collaborated with staff members to enhance customer service experience and exceed team goals through effective client satisfaction rates.
• Analyzed Denied Medical Claims: Conducted detailed reviews of denied medical insurance claims to determine the reasons for denial and identified potential areas for reconsideration or appeal.
• Communicated with Stakeholders: Liaised with claimants, healthcare providers, and internal teams to gather necessary documentation and information to support medical claim reconsiderations.
• Verified Enrollment Status: Provided timely and accurate information to healthcare providers regarding their enrollment status, including revalidation process every 5 years.
• Utilized Systems: Employed enrollment management software and databases to track provider status, update records, and generate reports for internal use and compliance audits.
• Provided Support: Assisted providers in navigating the enrollment process, offering guidance on necessary documentation and steps to complete their enrollment.

• Answered customer inquiries and provided accurate information about health plans and coverages that members are eligible for.
• Creating new applications and completing renewals for members health insurance.
• Performed data entry and maintained accurate records of policyholder information history.
• Assist members in understanding and selecting the most appropriate health insurance plans based on their individual needs and preferences.
• Assisted in the evaluation of insurance, identifying discrepancies and ensuring adherence to regulations.
• Resolved complex problems by working with other departments to provide solutions that meet customer needs.
• Answered inbound calls, chats and emails to facilitate customer service.
• Explain complex health plan details, including coverage limits, premiums, deductibles, and co-payments, in a clear and comprehensible manner.assistance.
• Asked probing questions to determine service needs and accurately input information into electronic systems.

• Maintained and organized files by keeping accounts payable record up to date.
• Processed payments and documents such as invoices, journal vouchers, employee reimbursements and statements.
• Reconciled financial accounts and identified discrepancies, resulting in improved accuracy of financial statements.
• Handled accounts payable and accounts receivable, resulting in improved cash flow and reduced overdue payments
• Directed clients to appropriate accountants, answered phone calls and replied to emails for excellent customer services.
• Applied proper codes to invoices, files and receipts to keep records organized and easily searchable.
• Used accounting software to prepare weekly and monthly financial reports.
• Developed and maintained an accounting system that improved accuracy and transparency of financial transactions

-

Payroll Duties

• Updated employee files with new details, such as change in address or salary levels.
• Maintained payroll information by calculating, collecting and entering data.
• Calculated salaries, rate change, retroactive adjustments, overtime, bonus, vacation, termination and garnishments.
• Reconciled payroll discrepancies and ensured all payroll data is accurate and up-to-date.