Summary
Overview
Work History
Education
Skills
Timeline
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Kelly Lightle

Lexington,NC

Summary

Business oriented with 7+ years of customer service experience within the insurance industry working with commercial, Medicaid, and Medicare. A proven record of accomplishment of excellent communication and innovation has led to project development and training, improving department efficiency, and developing talent within the organization. Able to work independently and efficiently, a 97% or higher satisfaction and quality rating maintained for the entire duration of employment, showing a strong work ethic and high quality of work.

Overview

9
9
years of professional experience
5
5
years of post-secondary education

Work History

Utilization Review Specialist

Carelon dba Elevance Health
01.2017 - Current
  • Provide authorization for different levels of mental health or substance use healthcare and post service requests utilizing scripts to screen basic and complex requests
  • Act as liaison between cross functional teams to coordinate complex tasks
  • Established training manuals for new hires
  • Develop and implement guidelines for new lines of business
  • Audit call quality for department quarterly to maintain standards of excellence
  • Perform smoke testing, or usability testing of system updates, identifying and reporting failures
  • Maintain certifications required by individual states, including yearly HIPAA compliance exams

formerly Beacon Health Options
01.2016 - 01.2017
  • Process customer requests including data collection, research, screening, verifying benefits and eligibility
  • Assess claims for accuracy for hospitals and private practices
  • Advise providers on next steps during claims process
  • Interact with customers clearly to ensure understanding of plan benefits, claims, and enrollment information, as well as increase customer satisfaction

Education

Bachelor of Science - Psychology

SUNY Oswego
08.2007 - 12.2010

Certification in Therapeutic Massage & Bodywork/ -

Cayce Reilly School of Massotherapy Virginia Beach
01.2007 - 08.2007

Associates of Liberal Arts and Sciences - Health Sciences

SUNY Sullivan
08.2005 - 12.2006

Skills

Type 68WPMundefined

Timeline

Utilization Review Specialist

Carelon dba Elevance Health
01.2017 - Current

formerly Beacon Health Options
01.2016 - 01.2017

Bachelor of Science - Psychology

SUNY Oswego
08.2007 - 12.2010

Certification in Therapeutic Massage & Bodywork/ -

Cayce Reilly School of Massotherapy Virginia Beach
01.2007 - 08.2007

Associates of Liberal Arts and Sciences - Health Sciences

SUNY Sullivan
08.2005 - 12.2006

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Kelly Lightle