Latia Clarke

• Help clients with reviewing their health care plan and help them evaluate their needs against the services and coverage they are eligible to receive
• Respond to customer inquiries and requests via telephone, email, and chat in a timely fashion. Document all inquires, requests, resolutions, and follow-up tasks prioritize tasks and manage time efficiently.
• Responded via telephone and email to questions regarding licensing, commissions, website logins and website navigation.
• Conducted research to answer questions and handle issues using multiple systems and resources.
• Adhered to health and prescription insurance products, delivery systems and claims systems.

Viewed reports regularly to make sure processing was conducted
efficiently.
•
Researched and resolved complex medical claims issues to support
timely processing.
•
Paid or denied medical claims based upon established claims
processing criteria.
•
Maintained knowledge of benefits claim processing, claims
principles, medical terminology, and procedures and HIPAA
regulations.
•
Processed insurance payments and maintained accurate
documentation of payments.
•• Monitored and updated claims status in claims processing system.
Identified and resolved discrepancies between patient information
and claims data.

• Skilled at working independently and collaboratively in a team environment.
• Self-motivated, with a strong sense of personal responsibility.

• Provide immediate assistance and support to, concerning escalated customer inquiries and issues
• Work with internal departments and contacts to resolve any discrepancies with the customers’ accounts
• Assist with updating account information, providing detailed plan information, and resolving issues with utilization of the plan
• Research any discrepancies with premium billing and prescription claims processed
• Assist pharmacies with prescriptions denials, errors, and verifying benefits
• Member services/convey health solutions
• Updated account information to maintain customer records.
• Investigated and resolved customer inquiries and complaints quickly.
• Educated customers about billing, payment processing and support policies and procedures.

• Researched and analyzed the customer’s account and determine the cause and provide a solution to satisfy the customer
• Used computer software to store and retrieve data.
• Followed data entry protocols, rules and regulations.
• Managed and organized documents for data entry tasks.
• Updated and maintained customer information, documents and records.
• Update account and billing information
• Educate customers on their plan structure and how the plan works
• Assist with claim review and any pharmacy discrepancies.
• Completed data entry tasks with accuracy and efficiency.
• Organized, sorted, and checked input data against original documents.
• Communicated with supervisors and colleagues to process data quickly and resolve discrepancies.
• Verified accuracy of data entered into system to produce error-free reports.
• Followed established procedures to enter and process data correctly.