Laila Khalaf
Tarzana,CA
Summary
Detail-oriented healthcare and insurance professional specializing in appeals, grievances, and claims resolution. Expertise in analyzing complex issues and ensuring regulatory compliance while delivering exceptional service. Skilled in communication, problem-solving, and multitasking in high-pressure environments, consistently achieving results with accuracy and professionalism.
Overview
10
10
years of professional experience
Work History
Appeals and Grievances Coordinator
SCAN
Long Beach, CA
02.2024 - 07.2026
- Managed appeals process, ensuring timely resolution and compliance with regulatory standards.
- Collaborated with healthcare providers to gather necessary documentation for grievance investigations.
- Processed and finalized appeals and grievances within agreed-upon turnaround time.
- Submitted verbal and written notification to members and providers.
- Maintained accurate records of all appeal cases, ensuring confidentiality and adherence to policies.
Appeals and Grievances Coordinator
Centene
Woodland Hills, CA
10.2021 - 07.2023
- Ensure compliance with company standards and regulatory requirements throughout the grievance and appeals process.
- Conducted outreach to gather essential information and documentation for comprehensive case reviews.
- Analyzed complex issues and employed critical thinking to efficiently resolve concerns and enhance case outcomes.
Broker Sales and Support Representative
Elevance Health
Woodland Hills, CA
08.2019 - 10.2021
- Assisted agents and brokers by responding to inquiries via telephone and written correspondence, ensuring timely resolution of concerns.
- Clarified inquiries regarding commissions, legislation, products, policies, and procedures to enhance agent understanding and compliance.
- Provided assistance with individual, small group, dental, and life insurance products to enhance client understanding.
Customer Service Representative
Joerns Healthcare
Chatsworth, CA
08.2017 - 07.2019
- Collected and evaluated information to identify opportunities for enhancing patient care and client satisfaction.
- Processed orders while coordinating equipment deliveries and pickups through phone and web portal systems to streamline service.
- Assisted Kaiser Permanente patients with inquiries and services. and ensured timely service fulfillment.
Primary Caregiver
Private Client
Van Nuys, CA
06.2016 - 08.2017
- Assisted with daily living activities, promoting independence and dignity.
- Provided compassionate personal care, enhancing client comfort and well-being.
- Monitored health status, reporting changes to healthcare professionals promptly.
Education
High School Diploma -
Buxton School
Williamstown, MABachelor of Science - Healthcare Management
University of Phoenix
Tempe, AZSkills
- Insurance operations
- Customer service
- Case Research & Investigation
- Regulatory Compliance
- Data Entry & Documentation
- Customer Service Excellence
- Case Documentation
Appeals & Grievance Resolution
- Agent support
- Critical thinking
- Claims Support
- Time Management
- Multitasking
- Adaptability & Flexibility
- Communication skills
- Process Improvement
Timeline
Appeals and Grievances Coordinator
SCAN
02.2024 - 07.2026
Appeals and Grievances Coordinator
Centene
10.2021 - 07.2023
Broker Sales and Support Representative
Elevance Health
08.2019 - 10.2021
Customer Service Representative
Joerns Healthcare
08.2017 - 07.2019
Primary Caregiver
Private Client
06.2016 - 08.2017
High School Diploma -
Buxton School
Bachelor of Science - Healthcare Management
University of Phoenix