Summary
Overview
Work History
Education
Skills
Timeline
background-images
Laurie Breisch

Laurie Breisch

Allentown

Summary

Experienced customer service professional with over 30 years of proven success in delivering exceptional service. Skilled in conflict resolution and efficient problem-solving. Thrives in high-pressure environments, adeptly balancing multiple tasks with precision and meticulous attention to detail.

Overview

30
30
years of professional experience

Work History

File Auditor

Aetna/CVS Health
07.2024 - Current
  • Members can request a file audit when they disagree with the deductible, co-insurance or benefit limits that were applied to their financials. I will perform the file audit to compare and match the amounts that were applied towards the member out-of-pocket limits according to how the claims were processed with a spreadsheet through Excel. I review and make changes or adjustments if necessary to any out-of-pocket limits that were applied incorrectly based on the review of the member benefits and how the claims are processed. When the file audit is complete I will email or mail the spreadsheet with my findings and corrections if applicable to the members.

Kana/Correspondence/Chat

Aetna/CVS Health
03.2022 - 07.2024
  • Help members when they send in emails, correspondence, and chat with question on their benefits or claims. Make sure the members have an understanding how their health insurance works. I will explain the members in-network and out-of-network benefits, so they have a full understanding of their medical coverage.

Sr. Health Concierge

Aetna/CVS Health
06.2020 - 03.2022
  • With my knowledge and experience growing I moved to a Senior Health Concierge that gave me the ability to not only help members with more difficult concerns, but it gave me the opportunity to help train and guide other employees to do the same.
  • Assisted with Coordination of benefits. Would review to determine which insurance company would process as primary, secondary, or tertiary payer. Follow guidelines with Employers, Medicare, and Medicaid so the members and the insurance companies are consistent with there payments.

Plan Coordination Consultant

Aetna/CVS Health
05.2017 - 06.2020
  • Manage and coordinate medical and wellness benefits.
  • Process and coordinate all plan benefit changes.
  • Updates structural and administration information into systems for on-line viewing, claims, enrollment, and billing purposes.

Sr. Health Concierge

Aetna/CVS Health
04.2015 - 05.2017

Health Concierge

Aetna/CVS Health
08.2012 - 04.2015
  • Transitioning to Health Concierge is to improve customer experience with providing more communication by answering the unasked questions, provide details to improve their understanding, by showing compassion in confusing health situations being the bridge with finding medical doctors to handle there needs by scheduling appointments for services, by following through with the member from start to finish.
  • I worked with hospital vertical plans which can offer the members a unique benefit if they use providers and facilities in their direct network. Educating members of the

Customer Service Representative

Aetna/CVS Health
06.1995 - 08.2012
  • Receive calls from members and providers in an inbound call center.
  • Explain in detail to members and providers the medical and dental benefit and plan options.
  • Help members and providers understand claims and how the claims are processed.
  • Provide empathy for member concerns.

Education

High School Diploma -

William Allen High School
Allentown, PA
05-1983

Skills

  • Excel
  • Word
  • Email (Kana)
  • Electronic Correspondence Handling System (ECHS)
  • Rumba
  • Aetna Strategic Desktop (ASD)
  • Guided Personal Service (GPS)
  • Teams

Timeline

File Auditor

Aetna/CVS Health
07.2024 - Current

Kana/Correspondence/Chat

Aetna/CVS Health
03.2022 - 07.2024

Sr. Health Concierge

Aetna/CVS Health
06.2020 - 03.2022

Plan Coordination Consultant

Aetna/CVS Health
05.2017 - 06.2020

Sr. Health Concierge

Aetna/CVS Health
04.2015 - 05.2017

Health Concierge

Aetna/CVS Health
08.2012 - 04.2015

Customer Service Representative

Aetna/CVS Health
06.1995 - 08.2012

High School Diploma -

William Allen High School

Similar Profiles

CREATE PROFILE