Lousaundra Drewery

Responsible for managing a case load of Absence cases including Paid Family Medical
Leave (PFML), Family Medical Leave Act (FMLA), Company Paid Leave (CPL), and
Americans with Disability Act of 1990 (ADA) and providing service excellence to GBS
customers.
Make determinations regarding a customer’s eligibility within compliance timeframes.
Manage an assigned desk load of leaves through capturing medical information,
managing certifications, applying appropriate provisions, following legal guidelines,
and leveraging expert resources.
Manage all requests within appropriate service and quality metrics and client
performance guarantees as defined.
Support ongoing leave management including extensions and reviewing of additional
information as needed to support updated claim decisions.
Effectively communicate with claimants, employers, and various medical
professionals to gather information regarding the application for, and ongoing
management of open leaves.
Initiate customer out reaches to gather information and respond to all telephonic and
email inquiries within customer service protocols and adhere to standard timeframes
for processing mail, tasks, and outliers. Execute all customer
performance guarantees as defined.
Proactively work directly with clients and Vocational Rehabilitation Counselors when
appropriate to facilitate return to work full-time or modified duty.

Ongoing development via training associated with role and business unit objectives.

• Accomplished multiple tasks within established timeframes.

• Confirmed all insurance benefits met standards of admissions as dictated by policy.
• Developed and implemented admissions policies for busy UPMC facility with more than 106 beds.
• Managed financial documentations such as expense reports and invoices.
• Carried out front office duties utilizing data entry skills in framework of medical database.
• Completed administrative patient intakes with case histories, insurance information and mandated forms.
• Received, recorded and addressed incoming and outgoing communication via telephone and email.
• Coordinated referrals through insurance and other medical specialists and documented details in patient charts.
• Answered telephone calls to offer office information, answer questions and direct calls to staff.
• Coordinated scheduling for patient appointments, enhancing operational efficiency across departments.
• Improved team productivity with regular communication and progress updates, fostering a collaborative work environment.

• Entered appeal requests in appeals module.
• Provided outreach for additional information for appeals and grievances.
• Completed in-depth investigations into issues pertaining to discipline and grievance management and recommended strategies.
• Streamlined documentation processes to enhance accuracy of appeals tracking systems.
• Managed emails, and fa
• Coordinated resolution of appeals and grievances, ensuring compliance with regulatory standards.
• Developed and maintained documentation for grievance procedures and policies.
• Monitored performance metrics to ensure adherence to quality guidelines in case management.

• Greeted customers and listened closely to problems described to determine solutions.
• Multitasked effectively to simultaneously handle website chat and telephone customers' needs.
• Audited documentation to identify errors and documented findings for review and action.
• Exceeded performance targets consistently by maintaining strong call control and calm in stressful situations.
• Coached new team members on service techniques and provided scoring through quality assurance program.
• Mentored staff on complex service issues, ensuring accurate resolution and enhancing team performance.
• Enhanced customer satisfaction by promptly addressing and resolving complex inquiries and complaints.
• Managed over 30 incoming calls. and Faxes per day from Customers
• Led resolution of complex customer issues, enhancing satisfaction and retention rates.
• Analyzed customer interactions to identify trends and recommend operational enhancements.
• Acted as an escalation point for challenging cases, demonstrating advanced troubleshooting skills while adhering to company policies.

• Assured timely verification of insurance benefits prior to patient procedures or appointments.
• Made contact with insurance carriers to discuss policies and individual patient benefits.
• Maintained strong knowledge of basic medical terminology to better understand services and procedures.
• Communicated verification and authorization status updates with department to facilitate decision-making for patient admissions and insurance coverage.
• Reviewed patient cases per week and verified insurance coverage information.
• Answered telephone calls to offer office information, answer questions and direct calls to staff.
• Reviewed 50 patient cases per week and verified insurance coverage information
• Analyzed patient records for accuracy, ensuring compliance with regulatory requirements and company policies.

• Completed professional development in Dental Assistant