Ledra Jordan-Brillson

Answering incoming calls from Employees regarding claim status and filing new reports.
Processing First Reports of Injury for Workers Compensation
Also performed outreach to internal Claims Examiners for additional claim information.

Demonstrating critical thinking skills and logical decision making.
Demonstrated ability to manage multiple tasks while remaining adaptable and flexible.
Participated in ongoing training to enhance own job skills and knowledge

Reviewing unemployment insurance claims with wages to determine if benefits are accurate. Analyzing all notes and documentation against State and Federal policies to determine if any discrepancies or to see what additional info is needed and if benefits were paid accurately. Also performed outreach to employers to obtain necessary information, document claim file and forward claim to necessary division to resolve any issues notated. Demonstrating critical thinking skills and logical decision making

Manage day to day operations and overseeing Case Managers. Answer and assist Case Manager questions with payments, housing/financial assistance and approvals for rental assistance. Review cases for eligibility requirements for tenants who have applied for assistance. Leading my team to have high metrics to meet company goals, create spreadsheets for daily reports, process a multitude of reports showing cases completed, aged cases, cases with missing documentation. Previously approving timecards. Heavy call volume with tenants regarding status of assistance pending approval. Multitasking with Case Managers and other internal employees with SOP development. Proofreading completed applications. .

Answer heavy incoming calls from members, dependents, hospitals, providers and agents. Interpret multiple different contracts in regards to benefits and claim inquiries. Researched multiple databases including claims and billing history to resolve membership issues. Provided a high degree of customer service including response via phone and email, making sure to resolve all member issues with first contact call. Also, assisted members with online navigation including policy type/explanation, claims history/status as well as provider navigation.

Answer incoming calls from physicians, nursing home staff and patients in need of referrals for Home Health services. Process incoming paperwork making sure all demographics are completed and signed. Outbound calls verifying insurance and obtaining eligibility.

Collected and reviewed all patient insurance benefit information. Provided assistance to physician office staff and patients to complete prior authorization requests for Home Health. Tracks and follows prior authorization process to make sure completed in a timely manner, as well as providing updates to physician and patients.

Register patients for surgery or clinical appointments, i.e. MRI, Xray or other imaging. Discharge clinical patients as well as assisting Radiology with necessary consent forms. Verify patients insurance prior to scheduled procedure, while making sure that all pre-authorizations are completed in a timely manner.