MARLO SHANNON

• Analyze and quote member benefits from Evidence of Coverage
• Analyze knowledge of BCBSM policies, practices, and procedures related to Professional or Facility claims processing, BlueCard processing, policies and procedures such as cost share, procedure and diagnosis codes
• Using IKA systems, Medicare.gov, Marx, Google, etc
• Organizes work to meet productivity and quality standards
• Outbound calls to Bluecard
• Identify authorizations
• Advise accumulators
• Written includes following calls, respond to Rn reviews, denial letters, following promise action guidelines
• Maintained calm, friendly demeanor with upset customers to de-escalate stressful situations
• Educated customers on campaigns
• Answered customer telephone calls promptly to avoid on-hold wait times

Particpates in the following Projects

Mpser Ro-ongoing

pay subscriber claim, verification of medical expenses,

change address letters, claims discrepancies-missing documentation

CMS Audit-July 2019

outbound calls to members with incorrect explanation of benefits retrieved from Excel

Material Request-May 2020-retrieve member data from excel spreadsheet to provide fulfillment materials

a. id card

b. welcome kit

c. provider directory

d. ach form

e. silver sneakers

State of Michigan Enrollment Outbound calls working from excel spreadsheet contacting SOM who have other MA Plans;

• Evaluates and price/adjudicates claims/inquiries. Interacts with others inside and outside organization to resolve inquiry/claim related problems
• Influences customers to accept reasonableness of decisions and actions .Proficient in NCSW, 3270, NCOMPASS, Benefit Explainer
• Other duties may be assigned
• Mail out Explanation of Benefit/ Qwik chart
• Providing accurate cost share accumulated totals
• Educated Subscribers on how to navigate company website to obtain desired services.