Kiesha Richardson

Work History

Aetna Better Health

Easton, PA

06.2023 - 12.2023

Assisted claimants, providers and clients with problems or questions regarding claims.
Research processed claims to inform provider, or members of current status.
Documented customer correspondence in CRM to track requests, problems and solutions.
Answered high volume of incoming calls during open enrollment answering various questions regarding members benefits, provider search to assist with finding different levels of care.
Walked members and providers through online registration process. T
Organized information by using spreadsheets, databases or word processing applications.
Worked with multiple departments throughout life of claim to ensure

United Healthcare Group

Bethlehem, PA

08.2020 - 05.2022

Approaches daily assignments with customer centric focus and sense of urgency and meeting tight deadlines.
Take inbound calls from employees checking the status of the group insurance applications for Life and Disability insurance.
Provide accurate and time sensitive information to both Clients and employees for quick an accurate processing of applications, and the implementation of benefits.
Make outbound calls for Omission in information to both Client and employees for missing information vital to the processing of submitted applications.
Research providers in and out of network for members.
Process Prior authorizations for medical procedures, in and outpatient stays and services.
Builds and maintains effective relationships with Underwriters and Sales matrix partners as needed to acquire or confirm information to ensure case can be properly processed.
Completing, documenting and referring risk reports.
Documenting underwriting analysis information in the electronic file; ensuring electronic file integrity.

Guardian Life Insurance

Bethlehem, PA

04.2019 - 03.2020

Responsible for making accurate decisions on assigned claims through proactive case management according to the plan provisions, state and federal guidelines, and established protocols. This position consults with other team members, as well as, the Professional Resource Team to assist claimants with return to work efforts when the capability and opportunity exist.
Utilize problem solving, analytical, written and verbal communication skills to deliver timely and appropriate disability claim decisions while providing superior customer service to all internal and external customers.
Partner with coworkers to broaden and enhance knowledge of complex claim handling. Handle claims within a variety of group sizes ranging from small (2+ lives) to large market (1000+ lives).
Responsible for determining integrated income to ensure appropriate financial risk and accurate payments are made.
Responsible for ensuring all plan provisions are met through the duration of the claim. Also consult with legal, investigative resources, and financial specialists.

Cigna

Bethlehem, PA

12.2016 - 02.2019

Reviewed, classified, coded and rated applications to support processing team during busy periods
Request and review medical records as needed, per policy guidelines.
Both a confident communicator and an independent decision-maker.
Provide mentoring/coaching to help develop technical skills of others, support team growth and development initiatives.
Participated in project work and on teams to develop or improve underwriting processes.
Ability to prioritize and efficiently handle multiple work items and due dates.
Use of Underwriting tools and systems.
Thorough knowledge of Group Insurance products/processes.
Excellent analytical and mathematical skills and ability to apply them to complex cases and issues.
Ability to make decisions, solve problems and meet challenges in completing work.
Strong negotiation and conflict resolution skills.
Proven ability to work independently.
Excellent verbal and written communication and presentation skills.
Effective use of Word, Excel and Powerpoint applications.
Continuously strives to provide superior customer service and support to teams.
Takes ownership for meeting individual performance objectives.

Office Team

Bethlehem, PA

01.2008 - 12.2015

Inbound calls from customer requesting information about their benefits or scheduled physicals.
Taking and completing orders from our outside sales teams.
Collections/ Filing/ Data Entry/ Order Entry.
Outbound sales calls to new and existing customers.
Assist customers in the Underwriting Call Center.
Research insurance applications for status to respond accurately and appropriately to customers.

MDS Pharmaceuticals

Neptune, NJ

01.2002 - 01.2008

Answer inbound calls from public interested in information regarding clinical studies.
Inform and educate participants of specific requirements and responsibilities for individual studies.
Outbound calling to participants from database.
Maintain levels of supplies, cards, envelop, etc.
Update teams with feedback to help recruiters meet their monthly goals.
Assist in training new recruiters.
Provide general leadership and advise recruiters on day to day questions and issues.