Keisha Woods

Answered over 100 inbound calls daily in a high volume setting, monitored medical, burglary, & fire alarms, dispatched emergency services, assisted customers with alarm issues & questions, and worked closely with emergency services for cancel of dispatch.

• Answered calls in high volume call setting, processed prescriptions, issued refill requests, answered emails, chats, and SMS messages, scheduled medication deliveries, and assisted with escalations.

• Assisted clinical staff with the approval of inpatient and outpatient surgeries, acted as a central point person for appeals & grievances, assisted providers with claims status and rejections, verified benefits and eligibility for Clover members, maintained clear and accurate logs of member demographics, identified and assisted team members with escalated issues, followed up with urgent provider issues, completed special project HEDIS promptly, triggered provider mailings in reference to healthcare changes, and assisted credentialing providers with application status and changes.

• Interacted with Clover members daily, resolved escalated member issues, assisted members with provider information, triggered mailings to members on healthcare changes, assisted with community resources to members when needed, scheduled staff care visits and wellness checks, monitored and followed up with members' needs, assisted members with benefit breakdown and copays, and completed special project HEDIS in a timely manner.