Lacey Carter

Within approved limits, applying claim settlement procedures to handle claims, initiate claim payment process, and close assigned files in partnership with the Claim Specialist. Using various electronic resources for claim handling. Applying knowledge of state and federal laws, statutes, and insurance regulations in claim handling. Following established procedures to appropriately review, handle, and settle applicable routine property and/or material damage claims. Researching, resolving, and settling claims involving injury within approved limits and/or as directed. Reviewing and applying policy coverage.

Subject Matter Expert. Handled customer service inquiries and problems via telephone, internet or written correspondence. Answered questions and resolve issues based on phone calls/letters from members, providers, and brokers. Triaged resulting rework to appropriate staff. Document and track contacts with members, providers, and brokers. Explained member's policy benefits and coordination with Medicare. Handled complaints (member/provider), via relevant recording/reporting system. Ensured compliance with requirements of regional compliance authority/Medicare. Determined applicable coverage provisions and verify member plan eligibility. Performed review of member claim history to ensure accurate tracking of benefit maximums. Performed financial data analysis as necessary. Used applicable system tools and resources to produce quality letters and spreadsheets in response to inquiries received.

Obtaining worker's compensation authorizations and insurance benefits and verifying eligibility. Verified patient information by interviewing patient, recording medical history and confirming purpose of visit. Helped with phlebotomy work by drawing blood for tests and giving common injections for immunization and treatment. Partnered with insurance company contacts to obtain authorizations related to performing medical procedures Assessed calls and inquiries to prioritize services based on medical emergencies. Protected patients' rights by maintaining confidentiality of medical, personal and financial information. Registered new patients and updated existing patient demographics by collecting detailed patient information. Cross-trained in front-office procedures to back up reception staff. Collected deductibles and copays to post money to patient accounts.