Lisa Dostie
Glade Hill, VA,VA
Summary
A seasoned professional from United Health Care, I excel in leveraging expertise in problem-solving and effective communication to drive operational improvements and enhance customer satisfaction. Known for resilience and subject matter knowledge, I've led initiatives that resulted in significant productivity enhancements across departments, embodying innovation and delivering results with accountability.
Overview
2025
2025
years of professional experience
1
1
Certification
Work History
Resolution Support Specialist/Expedited Appeals
United Health Care
07.2024 - Current
- Acts as a Subject Matter Expert for T1 advocates; assisting with processes, procedures, and systems related to M&R plans
- Provide T1 with educational information
- Uses expertise to assist other business groups, example: MA, Group, T3
- Identify gaps in processes and improvement needs, working with leaders and other departments
- Cross-trained and provided backup support for organizational leadership.
- Researches and owns complex issues across multiple databases, working with various resources to own the resolution of member issues
- Demonstrates the ability to work with minimal supervision
- Uses expertise to assist other business groups, example: MA, Group, T3
- Meets the performance goals associated with internal call support
- Expedited Appeals Role
- Investigate and respond accurately to post service questions/concerns that are presented on claims “Notice of Denial of Payment”
- Remained knowledgeable regarding company policies and procedures and current developments within operational departments.
- Understand legal expectations for informing and educating callers on appeals process and time frames
- Entered appeal requests in appeals module.
- Relay appropriate documentation needs for appeals, providing correct fax numbers to ensure CMS and UHC deadlines are met
- Apply critical thinking skills to respond and resolve complex Medicare and Medicaid DSNP appeals issues from member, Provider, and facility case manager calls
- Meet the performance goals associated with external call support
DSNP Pilot Navigator-SR
United Health Care
07.2021 - 07.2024
- Identified process improvement opportunities to enhance operational effectiveness and improve company wide productivity, resulting in company wide enhancements to several departments
- Provided quality customer service in a call center and assisting with escalated and complex issues
- Collaborated with cross-functional teams to streamline processes and ensure compliance with regulatory requirements for all plans
- Led training sessions for internal staff and external partners on DSNP program details and best practices for navigating complex healthcare systems
- Participated in industry conferences and forums to stay current on industry trends, market developments, and emerging best practices for all members
- Serve as the point of contact for escalated customer service issues and identify solutions to maintain service level goals and ensure customer satisfaction
- Maintained in-depth knowledge of product lines to provide customer education on benefit inquiries, and assist customers quickly
- Served as a subject matter expert on DSNP and Medicare and Retirement regulations and best practices delivering trainings to team members to enhance understanding and compliance
Outbound Call Center
United Health Care
10.2018 - 07.2021
- Demonstrated excellent communication skills and maintained a professional demeanor while engaging with customers to address inquiries and provide information.
- Utilized CRM systems to accurately record customer interactions, update contact information, and schedule follow-up calls to nurture relationships.
- · Made outbound calls to educate Employer Group/Individual Plan members on important changes to their plan and retain them by explaining benefits in keeping plan.
- · Made outbound calls to welcome new Employer Group/Individual Plan members to the plan and to ensure they have a firm understanding of how the plan works and address and questions or concerns before their plan goes into effect.
Application for Denial(ADP)
United Health Care
- Communicated with applicants regarding the status of their application and provided guidance on next steps
- Collaborated with internal teams to gather additional information or documentation needed for processing denial applications efficiently
- Maintained detailed records of denial applications, correspondence, and decisions made for audit and reporting purposes
- Evaluated applications based on company policies and guidelines to determine eligibility or denial
- Processed and reviewed applications to verify accuracy of information provided and ensure compliance with legal regulations
Education
Messalonskee High School
Oakland, Maine06-1994
Skills
- Subject Matter Expert
- Collaborating
- Solving Problems
- Communicating with Others
- Resilience and Resourcefulness
- Being Accountable
- Supporting Innovation and Creativity
- Self Management
- Using Time and Resources Effectively
- Delivering Results
- Serving Customers
- Understanding Goals, Priorities and Plans
Accomplishments
Compliance Champ
Refresh Academy
EEX Committee
Certification
Medicare and Retirement
Completed levels 1,2 and 3
Timeline
Resolution Support Specialist/Expedited Appeals
United Health Care
07.2024 - Current
DSNP Pilot Navigator-SR
United Health Care
07.2021 - 07.2024
Outbound Call Center
United Health Care
10.2018 - 07.2021
Medicare and Retirement
Completed levels 1,2 and 3
Application for Denial(ADP)
United Health Care
Messalonskee High School
Similar Profiles
Selena SanchezSelena Sanchez
Claims Specialist at United Health CareClaims Specialist at United Health Care
Lakshmi NarayanaLakshmi Narayana
EDI Specialist at United Health CareEDI Specialist at United Health Care
Simone BarnesSimone Barnes
Clinical Administrative Coordinator at United Health CareClinical Administrative Coordinator at United Health Care