La’Joye Waldon

Handled incoming/outgoing calls to members and providers. Reviewed medical claims along with initiating/reviewing claim disputes/appeals. Initiated/review member grievances/complaints. Initiate/review prior authorization appeals (medical/DME/pharmacy). Processed premium payment/review payment history. Reviewed Medicare Part B, C (Medicare Advantage), and D benefits. Trained new hires. Evaluated employee performance and coached to improve weak areas. Applied strong leadership talents and problem-solving skills to maintain team efficiency and organize workflows. Developed member care plan. Educated member on benefits and materials. Scheduled and located providers for member appointments. Gathered, organized and input information into database. Educated member on gaps in care. Resolved member complaints

Delivered individualized patient care by recording vital signs, documenting observations, administering treatments, and evaluating patient needs. Promoted good oral and personal hygiene by aiding patients with shaving, bathing, and teeth brushing. Changed linens in rooms, keeping spaces fresh and clean for patient health and satisfaction. Helped patients complete range of motion exercises to prevent loss of function during care.

Responded to customer requests for products and services. Answered customer telephone calls promptly to avoid on-hold wait times. Actively listened to customers, handled concerns quickly and escalated major issues to supervisor. Clarified customer issues and determined root cause of problems to resolve product or service complaints. Calculated correct order totals, updated accounts, and maintained detailed records.

Handled incoming and outgoing calls for sales. Offered advice and assistance to customers, paying attention to special needs or wants. Stayed up to date on software and hardware updates to optimize efficiency and productivity for management of clients. Resolved computer and system networking problems.