Dedicated and adaptable professional with a proactive attitude and the ability to learn quickly. Strong work ethic and effective communication skills. Eager to contribute to a dynamic team and support organizational goals.
Hi, I’m
LaShawn Ray
Detroit,MI
Summary
Overview
20
Customer Service and health care services
15
Certified Nurse Assistant Certification
Work History
AmeriHealth Caritas (Blue Cross Complete of MI)Southfield, MI
Personal Care Connector
11.2017 - Current
Job overview
- Performed support daily with operations of integrated care management and utilization management program interventions.
- Performed in a contact center environment, effectively processing calls to and from Members, Providers, and other areas, internal and external to the company.
- Identified members with Care Gaps/HEDIS-related health conditions and assist them in accessing care through Plan benefits and community resources.
- Provided members with educational materials and carried out strategies to increase healthcare adherence and reduce barriers to care.
- Performed eligibility verification through the MI Health website.
- Reviewed claims and providers of members through Facets.
- Performed assessments for Children’s Special Health Care Services (CSHCS) and Bright Start program to determine whether case management was needed.
- Provided individuals and families with information and resources to connect with available programs.
- Facilitated communication between departments throughout the company in order to provide a unified approach towards meeting customer needs.
- Maintained accurate records and documented client data in company databases.
- Provided referrals for specialized care when necessary.
- Participated in community outreach events to promote awareness of medical services available.
- Coordinated transportation arrangements for those unable to travel independently.
- Scheduled appointments and procedures for patients at various facilities or locations.
- Maintained awareness of government regulations, health insurance changes and financing options.
Proctor FinancialTroy, MI
Loss Drafts Associate
01.2017 - 04.2017
Job overview
- Built relationships with customers by providing friendly customer service.
- Managed multiple tasks simultaneously while maintaining attention to detail.
- Maintained up-to-date information on claims processing guidelines and health plan benefits.
- Responded promptly to customer inquiries via email or telephone calls.
- Researched payment histories and updated records accordingly.
- Assessed loan documentation to identify discrepancies with title insurance companies.
- Maintained accurate tracking systems to monitor progress of each case.
- Drafted correspondence for external vendors as needed.
- Processed incoming payments and verified receipt of funds.
- Analyzed loan files for compliance with federal, state, and local regulations.
- Verified signatures on legal documents before submitting them for approval.
- Reviewed and processed loss draft documents to ensure accuracy of information.
- Processed claims for payment or forwarded to appropriate personnel for further investigation
- Corresponded with insured or agent to obtain information or inform of account status or changes.
- Drafted statements of loss to summarize payments, underlying policy coverages and damages.
- Prepared and reviewed insurance-claim forms and related documents for completeness.
General Motors Co.Warren, MI
Senior Advisor, Case Management.
09.2014 - 08.2016
Job overview
- Communicated with management for approvals to disburse insurance claim funds on delinquent mortgage loans.
- Communicated with automotive owners regarding mechanical and dealer complaints.
- Provided dealer location and referrals.
- Accurately interpreted, explained, and clarified warranties and safety recalls.
- Resolved issues at the lowest possible level and escalated to management when necessary.
- Effectively communicated with dealerships and GM personnel to resolve vehicle issues.
- Participated in scheduled meetings to enhance departmental performance and teamwork, performed research that looks for root causes, and informed leadership of trends.
- Performed floor support, assisting management with escalations and case closures.
- Processed various goodwill vouchers (warranty extensions, OnStar, XM radio, and Owner’s loyalty certificates, etc.) Assisted customers and providers with various medical insurance policies (HMO, PPO, EPO, EPA, POS and HCR) regarding all aspects of claims (receipt of claims, coordination of benefits, copayments, payment amounts and dates; status of authorizations, receipt of bill, and interim bills paid and amounts)
Health Alliance Plan (HAP)Detroit, MI
Benefits Representative
09.2013 - 04.2014
Job overview
- Inbound and outbound communication via phone or email for customer care.
- Assisted with addressing insurance claim concerns regarding the processing of funds.
- Reviewed and monitored disbursements of claim funds as required documents are attached to the claim accordingly, per policy and guidelines.
- Accurately document each customer phone call, email, and track data through completion of claim or close of call with all pertinent information, and correctly route resolution.
- Communicated effectively via email, phone and face-to-face with plan participants to resolve issues pertaining to health and welfare benefits.
- Stayed current with benefits trends and legislation through continuous education and professional development.
Detroit Public SchoolsDetroit, MI
Paraprofessional (Autistic Dept.)
03.2008 - 09.2013
Job overview
- Cared for special needs students with various disorders / impairment (Asperger’s, Autism (high functioning, mild and severe) for middle school and pre-k
- Assisted teachers with setup of assignments in preparation of weekly planning of instructional materials and classroom management.
- Participate in individualized evaluation plans and behavioral intervention plan meetings with teachers and parents to discuss progress for present and future classroom placement.
- Assisted with connecting parents with programs (NSO, Easter seals, etc.) For medical, year-round assistance, after-school and summer programs to help maintain or increase progression for students with special needs.
- Monitored and/or fed students during breakfast and lunch, if a student's condition required assistance.
- Chaperoned student to appropriate support service (PT, OT, Social worker, etc.) Transportation, restroom.
- Created and maintained positive relationships with students, parents, and colleagues.
- Attended professional development workshops related to job responsibilities.
- Ensured that all safety regulations were followed in the classroom environment.
- Observed students to help teachers identify potential learning blocks and opportunities for support.
- Provided one-on-one support to students requiring additional assistance with assignments.
- Applied positive reinforcement to redirect negative behaviors.
Aditya Birla MinacsFarmington Hills, MI
Express Scripts (Pharmacy Help Desk agent)
10.2011 - 05.2012
Job overview
- Researched required information using available resources to maintain customer satisfaction.
- Received and input orders, answered inquiries, handled complaints, and troubleshooted technical issues with streaming devices.
- Provided prescription overrides to various pharmacies when requested.
- Maintained a knowledge base of commonly asked questions and their solutions.
- Interfaced with third-party vendors for problem resolution when necessary.
- Logged all customer interactions in ticketing system for tracking purposes.
- Researched, documented and escalated support cases to higher levels of support when unable to resolve issues using available resources.
- Assisted with customer requests and answered questions to improve satisfaction.
Education
Wayne County Community CollegeDetroit, MI
Associates Degree in General Studies
06-2009
University Overview
Marygrove CollegeDetroit, MI
Some Classes Taken Towards Bachelor’s Degree
University Overview
Davenport UniversityWarren, MI
Some classes taken towards Bachelor’s Degree
University Overview
Skills
- Microsoft Word
- Outlook
- PowerPoint
- Excel
- CPR and First-Aid Certified
- CPT and ICD-9 Coding
- Document Management
- Positive Attitude
- Data Collection
- Client Relationship Management
- Analytical Thinking
- Type 35 WPM
- Community Engagement
- Problem-Solving
- Medical terminology proficiency
Certification
- Certified Nurse Assistant certification - Wayne County Community College
References
References
References available upon request.Availability
See my work availability
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Available
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tuesday
wednesday
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friday
saturday
sunday
morning
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evening
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Timeline
Personal Care Connector
AmeriHealth Caritas (Blue Cross Complete of MI)
11.2017 - Current
Loss Drafts Associate
Proctor Financial
01.2017 - 04.2017
Senior Advisor, Case Management.
General Motors Co.
09.2014 - 08.2016
Benefits Representative
Health Alliance Plan (HAP)
09.2013 - 04.2014
Express Scripts (Pharmacy Help Desk agent)
Aditya Birla Minacs
10.2011 - 05.2012
Paraprofessional (Autistic Dept.)
Detroit Public Schools
03.2008 - 09.2013
Wayne County Community College
Associates Degree in General Studies
Marygrove College
Some Classes Taken Towards Bachelor’s Degree
Davenport University
Some classes taken towards Bachelor’s Degree
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