Kelley D. Perez
San Rafael,USA
Summary
Experienced in member care, consistently providing exceptional service and efficient problem resolution. Proven ability to support and collaborate with team members to achieve common goals. Known for adaptability and reliability, excelling in dynamic and fast-paced environments.
Overview
20
20
years of professional experience
Work History
Member Care Specialist
CareCounsel, LLC
06.2016 - 04.2024
- Managed high volume of calls while executing Stanford Hospital’s well-established world-class service to resolve member and physician questions and issues related to the HMO administrative processes, to include claim payments, authorization/referral management, and eligibility management.
- Managed 50+ calls a day.
- Resolved member and provider issues related to claim payments, authorizations, referrals, and eligibility using Epic, Tapestry and CRM system.
- Effectively managed and prioritized workload to promptly respond to patients and provider questions and requests using Outlook and CRM system.
- Anticipated patient and provider needs to ensure superior customer service.
- Navigated complex proprietary software, Epic and Microsoft Office
Senior Benefit Analyst
Genworth Life Insurance Co.
01.2004 - 01.2016
- Accountable for adjudicating Long Term Care claims according to multiple contracts. Obtained medical records and objective information needed to adjudicate claims accurately and objectively according to complex policy eligibility requirements. Responded to intake calls and other notice of claim methods.
- Accountable for working within a referral matrix that maximized the expertise of internal and external resources to ensure consistency of claim practices.
- Subject matter expert on contracts and procedures
- On and off-site Mentor/trainer
- Created pilot program to streamline workflow and decrease claim cycle time.
- Created a workflow template that was added to standard operating procedures.
- Managed policy holder issues and complaints to mutual resolution
- October 2016 to June 2017: 9-month hiatus after office closure during which I cared for my mother.
- April 2024 to present: Moved from California to Texas in April 2024
Education
High School Diploma -
Montgomery High School
Santa Rosa, CASkills
- Excellent customer service skills and phone acumen
- Experience with Long Term Care insurance contracts and claims
- Extensive experience in high-volume customer service
- Experienced in handling multiple responsibilities
- Excellent interpersonal and critical thinking skills
- Able to build strong working relationships by demonstrating respect, collaboration and acting on performance feedback
Timeline
Member Care Specialist
CareCounsel, LLC
06.2016 - 04.2024
Senior Benefit Analyst
Genworth Life Insurance Co.
01.2004 - 01.2016
High School Diploma -
Montgomery High School
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