Marti Williams
307-780-5899
West Valley City,UT
Summary
Demonstrative Eligibility Specialist proudly offering over 20 years' experience assisting others with enrollment and program services. Polished professional known for interactions that are fair, compassionate and respectful. Promoting issue resolution expertise in fast-paced environments.
Overview
8
8
years of professional experience
Work History
Care Management, Medicare Specialist
Aetna, a CVS Health
West Valley City, UT
08.2019 - 12.2023
- Monitored updates from CMS regarding changes that affect patients' access to care covered by their plan.
- Evaluated customer feedback concerning their experience with the organization's Medicare services.
- Provided beneficiaries with information about plan benefits and eligibility determinations.
- Responded to member questions regarding plan benefits and provisions.
- Investigated complaints received from customers about errors made when processing their claims or incorrect information provided about coverage options under their plan.
- Answered questions and responded to inquiries to deliver high level of service to patients.
- Maintained confidential patient documentation to prevent data compromise and comply with HIPAA regulations.
- Provided customer service support for clients seeking information about Medicare coverage.
- Ensured all documentation was completed correctly before submitting it for approval or payment processing according to established guidelines.
- Reviewed Medicare claims to ensure accuracy and compliance with regulations.
- Explained eligibility details and affordability options to patients with kindness and respect.
- Participated in meetings with other departments to discuss changes affecting Medicare coverage plans.
- Completed day-to-day duties accurately and efficiently.
- Assisted with customer requests and answered questions to improve satisfaction.
- Identified needs of customers promptly and efficiently.
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
- Displayed strong telephone etiquette, effectively handling difficult calls.
Senior CSR
Delta Health Systems
Salt Lake City, UT
05.2016 - 12.2019
- Escalated calls to solve problems and drive customer satisfaction.
- Collaborated with both provider and member calls.
- Referred claims that required special attention to correct.
- Processed Claims due to incorrect service and authorization
- Answered questions due to benefits, eligibility.
- Worked with Cigna, Select Health, Blue Cross Blue Shield Anthem , Delta Dental Claims as Third Party Health Care Coverage.
Education
High School Diploma -
Lyman High School
Lyman, WY05-2001
Skills
- Negotiation Tactics
- Customer Service Expertise
- CMS Guidelines
- Networking and Relationship Building
- Proficiency in Next Gen, Citrix, Epic, Microsoft Office including teams Verint, Express Scripts, Care Centrix, Evicore, My Advocate, CMS Medicare, Delta Dental, Blue Cross Blue Shield Alldate Caremark Pharmacy log in for coverage Avaya Phone etc
- Effective Communication Skills
- Advocacy and Counseling
- Documentation and Paperwork
- Telephone Etiquette
- Program Understanding and Advisement
- Applicant Support and Service
- Eligibility Determination
References
References available upon request.
Timeline
Care Management, Medicare Specialist
Aetna, a CVS Health
08.2019 - 12.2023
Senior CSR
Delta Health Systems
05.2016 - 12.2019
High School Diploma -
Lyman High School
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