LACONDIA MOORE

• 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.

• 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

• 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.