Lavern Hinton
Summary
Qualified CSR with comprehensive background in managing appeals and grievances. Coordinated complex cases, ensuring timely and effective resolution, and enhancing client satisfaction. Demonstrated strength in communication and problem-solving, facilitating seamless team collaboration and continuous process improvement.
Overview
10
10
years of professional experience
Work History
Appeals and Grievances Coordinator
Skygenusa
05.2018 - 04.2025
- Managed inbound and outbound calls to address customer inquiries effectively.
- Resolved escalated issues for members and providers, ensuring satisfaction.
- Conducted thorough research to address concerns related to accounts and services.
- Collaborated on special projects to enhance operational efficiency.
- Identified and classified various document types including claims, authorizations, complaints, and appeals.
- Worked with team members to meet turnaround times and service level agreements consistently.
- Entered appeal requests in appeals module.
- Maintained strict confidentiality of sensitive member information while adhering to HIPAA regulations during case investigations.
- Demonstrated high-level attention to detail when reviewing medical records, provider contracts, and other relevant documents during case assessments.
- Ensured timely submission of required reports to regulatory agencies by diligently monitoring deadlines and maintaining accurate records.
Team lead
Duncan Solution
08.2015 - 02.2018
- Collected outstanding balances to ensure timely financial reconciliation.
- Educated customers on toll and parking violations to promote compliance.
- Processed payments efficiently, enhancing cash flow management.
- Researched and resolved citizen concerns to improve service satisfaction.
- Handled inbound and outbound calls to address customer inquiries effectively.
- Managed escalated calls, providing solutions for account-related issues.
- Promoted a positive work environment by fostering teamwork, open communication, and employee recognition initiatives.
- Worked different stations to provide optimal coverage and meet production goals.
- Collected, arranged, and input information into database system.
Education
High School -
Learning Enterprise
06.1998
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Milwaukee Police Department Citizen Class Academy
11.2008
Skills
- Microsoft Office Suite
- Oracle Database Management
- Computer literacy
- Interpersonal skills
- Verbal and written communication
- Dispute resolution
- Teamwork and collaboration
- Problem-solving
- Time management
- Multitasking skills
- Attention to detail
- Multitasking Abilities
- Reliability
- Excellent communication
- Organizational skills
Timeline
Appeals and Grievances Coordinator
Skygenusa
05.2018 - 04.2025
Team lead
Duncan Solution
08.2015 - 02.2018
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Milwaukee Police Department Citizen Class Academy
High School -
Learning Enterprise
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