LATOSHIA MCKOY

• Explained Plan options to Medicare recipients
• Meet sales goals
• Sold Medigap, Medicare Advantage, PDP and ancillary plans
• Identified customer needs by asking questions and advising on best solutions.
• Monitored industry news, developments, and trends related to our products and services.
• Continuously met sales goals via strategic prospecting.
• Set up meetings with potential clients and listened to their wishes and concerns.
• Listened to customer needs to identify and recommend best products and services.
• Followed up with prospects on a regular basis to ensure satisfaction with services provided.
• Answered customer questions and responded quickly to problems and complaints in person, on phone and by email.

• Assist members and providers with resolving eligibility and claim issues
• Inbound Call Center
• Customer Service.
• De-escalated problematic customer concerns, maintaining calm, friendly demeanor.
• Resolved customer complaints promptly and efficiently.

• Specialize in working with seniors, educating them on how Medicare works, and the various supplement plans that are available to them.
• Licensed Life and Health Insurance Sales Representative in 50 states.
• Specializing in offering Medicare Insurance Plans.
• Adhere to state and federal laws, and compliance rules.
• Manage individual health insurance plans in a book of business.
• Microsoft Office.
• CRM

• Company Overview: CVS/Aetna is a health care company that provides a range of health insurance products and services
• Licensed Life and Health Insurance Sales Representative in 50 states
• Specializing in offering Medicare Insurance Plans.
• Adhere to state and federal laws, and compliance rules.
• Manage individual health insurance plans in a book of business.
• Microsoft Office
• CRM
• SalesForce
• CVS/Aetna is a health care company that provides a range of health insurance products and services

• State, federal, and CVS/Aetna compliance requirements.
• Subject Matter Expert (SME) for business leaders and frontline staff.
• Contributed to the overall clinical organizations' UM decision-making audit score of 90% or greater.
• Trained personnel on proper use of tools, equipment, materials, and software used for quality assurance purposes.
• Implemented corrective actions when necessary to improve overall product quality.
• Collaborated with cross-functional teams to ensure that product specifications are met or exceeded.

• Communicate Authorization status with medical offices and facilities
• Administration Assistant for Medical Directors and Nurses
• Handled Clinical record request
• Assisted in coordinating referrals for medical specialists or other services when necessary.
• Answered phone calls and responded to questions and concerns.
• Facilitated communication between healthcare providers, family members and other stakeholders involved in a patient's care plan.
• Transmitted medical records and other correspondence by mail, e-mail, or fax.
• Collaborated with multidisciplinary teams to ensure patients received appropriate services and resources.
• Arranged hospital admissions for patients as required.

• Place outbound calls to members.
• Assessed patient understanding of key concepts through individual interviews or focus groups.
• Worked with state clients and stakeholders to shape procurements and identify opportunities for value added services.
• Educated members about preventive health care.
• Assisted with scheduling medical appointments.
• Addressed transportation and financial barriers.

• Initiated collection activities on delinquent accounts while adhering to HIPAA guidelines and regulations.
• Reached out to patients once insurance was billed in order to obtain payments due.
• Recorded information about status of collection efforts.
• Reviewed EOBs statements submitted by insurance companies for accuracy against provider's charges.
• Reviewed flagged items daily and resolved issues.
• Received payments and posted amounts to customer accounts.

Monitored overdue accounts using automated information systems.

• Receive incoming calls from members with Group Accounts (Dedicated ASO teams, and Performance Guaranteed Accounts).
• Explain claims and benefit information to members.
• Advocated for members by making provider outreach calls and communicating with other UHC departments to resolve issues.
• Committed to and followed through on issues.
• Educated members on how to maximize their health care benefits.
• ISET, UNET, CAMS, SharePoint, RightFax.
• Performed account changes, such as updating coordination of benefits, Medicare eligibility, and student status changes.
• Adhered to HIPAA guidelines.
• Assisted patients in navigating the healthcare system by providing resources and referrals as needed.
• Managed many health plan-related calls in fast-paced call center environment.
• Answered questions on diverse topics, including authorization procedures, copay requirements and premiums.
• Researched and corrected customer issues in areas such as plan benefits, coverage eligibility, and claims processes.