Kelsey Tahakjian

Delivers specific delegated Claims tasks assigned by a supervisor.
· Examines and processes paper claims and/or electronic claims.
· Determines whether to return, pend, deny or pay claims within policies.
· Determines steps necessary for adjudication.
· Follows established departmental policies and procedures, operating memos and corporate policies to resolve claims and claims issues.
· Settles claims with claimants in accordance with policy provisions.
· Compares claim application and/or provider statement with policy file and other records to evaluate completeness and validity of claim.
· Interacts with agents and claimants by mail or phone to correct claim form errors or omissions and to investigate questionable entries.
· Completes day-to-day tasks without immediate supervision, but has ready access to advice from more experienced team members.
· Tasks involve a degree of forward planning and anticipation of needs/issues.

Eligibility to receive benefits associated with their individual or company sponsored health insurance plan
· Determination of out of pocket costs related to medical or dental office visits, prescription medications, inpatient and outpatient procedures, diagnostic imaging for treatment of injuries, medical equipment and preventive care
· Understanding of payments and claims related to office and hospital visits and medical and dental procedures, and thoroughly explaining how customer benefits are applied to costs associated with these visits and procedures
· Finding an in-network primary care or specialist doctor in a geographical area or specialty
· Education on disease management programs and healthy living programs personalized to the customer’s medical condition or health improvement goals.

Managing a team of Medicare ARC (Advanced Resolution Center) customer service representatives.
· Performance management and leadership
· Special projects development for upper management
· Watch the queue to ensure all calls are being answered in a timely manner
· Assign escalations to all the customer service representatives in the Medicare ARC
· Keep track of any possible trends in the Medicare ARC
· Ensure team’s SLAs and inbound goals are being met
· Handle manager’s calls
· Point of Contact for the .gov delivery and MyMedicare.gov cases
· Responsible for setting up the ARC Team Meeting Agenda tri-weekly
· Present ARC Team Meeting tri-weekly

Customer Service, handling all customer complaints and resolving complaints
• Multi line phone system and data entry
• Liaison between agencies and customers
• Handle inbound and outbound calls
• Meet two days SLA for assigned calls
• Handle casework from CMS
• Resolving complex issues and inquiries
• Providing customer service and assisting customers with different issues
• Communicating with different agencies such as Social Security Administration and Medicaid to resolve customer's issues
• Enrolling customers into Medicare Part D and Medicare Advantage Plans
• Follow the HIPAA and Privacy Act of 1974 to protect customer's personal information

• Enhanced client satisfaction by addressing concerns promptly and providing exceptional service.
• Generated additional sales opportunities with upselling and cross-selling techniques.
• Expanded customer base through cold calling, networking, and relationship building.
• Increased sales revenue by identifying and targeting high-potential accounts.