Resourceful Customer Service Driven Insurance Professional promoting 10 years of expertise assessing coverage and overseeing claims review. Leverages well-developed communication skills to deliver information to policyholders.
Overview
5
5
years of professional experience
Work History
STD/FMLA Claims Specialist
Metlife
Aurora, IL
07.2021 - Current
Reviewed new files to determine current status of injury claim and to develop plan of action.
Provides timely, balanced and accurate claims reviews, documentation and recommended
decisions in a time sensitive and fast-paced environment and in accordance with state and
department of insurance regulations
Provides frequent, proactive verbal communication with our claimants and/or their
representatives demonstrating empathy and active listening while providing clear updates,
direction and explanations regarding the claim process, benefits and other pertinent plan
provisions. These calls are used to gather essential details regarding medical condition(s) and
treatment, occupational demands, financial information and any other information that may be
pertinent to the evaluation of the claim. Once telephone calls are completed, you will be
required to document the conversation within the claim file in a timely manner utilizing the
appropriate level of detail and professional writing skills
Interacts and communicates effectively with claimants, customers, attorneys, brokers, and
family members during claim evaluations
Compiles file documentation and correspondence requiring extensive policy and factual detail.
Analyzes information to determine if additional information is needed to make a reasonable and
logical claims determination based off the information available
Collaborates with both external and internal resources, such as physicians, attorneys,
clinical/vocational consultants as needed to gather data such as medical/occupational
information in order to ensure reasonable, thorough decisions.
Insurance Verification Specialist
LifeStance Health, Edgewood Clinical Services
Naperville, Illinois
01.2020 - 07.2021
LifeStance Health offers a range of specialized behavioral therapy services, they aid those suffering from mental health disorders
As the Insurance Verification Specialist, I had the responsibility of assisting the Insurance Verification Specialists to verify patient medical insurance benefits through phone and online access of private insurance companies,
Medicare, and Medicaid to obtain benefit information
Determined insurance benefit compatibility with LifeStance procedures/visits Re-verify existing patient insurance coverage and determine if insurance benefit plan considers selected products appropriate based on patient need
Obtained pre-certification or authorization for procedures and enter into billing system so ware
Completed data entry and/or appropriate forms to document patient's benefits coverage
Alerted Office staff about uninsured or underinsured patients
Provided accurate, detailed insurance benefits to requester and detail in the billing system
Client Services Representative
DELTA DENTAL ILLINOIS
Naperville, Illinois
01.2018 - 01.2020
Delta Dental is the largest dental plan system in the United States, also known as Dental Service of Massachusetts
Delta Dental Plans Association is composed of 39 independent Delta Dental member companies opera ng in all 50 states, District of Columbia and Puerto Rico
Client Services Representative
As CSR, I was tasked with rapid response to telephone or written correspondence inquiries from members and/or providers to explain insurance benefit information
Explained HMO vs
PPO policies and how benefits differ
Assisted members and/or providers regarding website registration and navigation
Maintained performance and quality standards based on established call center metrics including turn-around times
Researched and identified processing inaccuracies in claim payments and adjusted claims appropriately
Processed checks, stop payments, readjust claims for payment
Processed credit card payments and ACH payments for individual policyholders' premiums
Assist supervisors and department with multiple special projects using expert time management with little to no supervision.