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Michelle Lopez
United Healthcare employee
Geneseo,IL
Work Preference
Desired Job Title
Case Prep Appeals CoordinatorAppeals RepresentativeCustomer Service RepresentativeCommunity And State Member AdvocateRetenion SpecialistWork Type
Full TimeLocation Preference
RemoteSalary Range
$56000/yr - $200000/yrImportant To Me
Company CultureFlexible work hoursWork from home optionPaid time off401k matchPaid sick leaveHealthcare benefitsStock Options / Equity / Profit SharingSummary
Experienced with appeals processing and regulatory compliance. Utilizes analytical skills and effective communication to facilitate dispute resolution. Knowledge of workflow optimization to improve efficiency and resolution times.
Professional appeals specialist prepared for roles that demand high standards and results-driven approach. Proven track record in managing complex appeals, leading to successful outcomes and enhanced procedural efficiency. Collaborative team player with focus on adaptability and achieving organizational goals. Strong skills in dispute resolution and regulatory compliance.
Overview
12
12
years of professional experience
Work History
Case Prep Appeals Coordinator
UHC
11.2023 - Current
- . I prepare appeal request for clinical review.
- . I reach out to providers to confirm facility information
- . I search for and download medical policies and documents
- . I research and download employee benefit documents
- . I review medical claims
- . I search for member eligibility
Appeals Representative
Clinical Appeals Closure Team
01.2022 - 11.2023
- Verified and reviewed information
- Ensured confidentiality of sensitive information by following strict security protocols throughout the appeals process.
- Implemented quality control measures to enhance accuracy in appeal resolutions.
Customer Service Representative
Optum
05.2019 - 01.2022
- I assisted callers with numerous health plans with accident or injury claims.
- I assisted members with questions they may have regarding their healthcare benefits.
- I communicated via email and management daily.
- United Healthcare, Advocate for me
- Worked effectively in fast-paced environments.
- Self-motivated, with a strong sense of personal responsibility.
- Proven ability to learn quickly and adapt to new situations.
- Managed time efficiently in order to complete all tasks within deadlines.
Community And State Member Advocate
United Healthcare
Davenport, IA
03.2017 - 05.2019
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
- Maintained detailed records of customer interactions, ensuring proper follow-up and resolution of issues.
- Assisted customers in navigating company website and placing online orders, improving overall user experience.
- Exceeded performance metrics consistently, earning recognition as a top performer within the team.
- Fostered positive customer service culture within team which led to higher customer satisfaction rates.
- Met customer call guidelines for service levels, handle time and productivity.
- Educated customers about billing, payment processing and support policies and procedures.
- Developed highly empathetic client relationships and earned reputation for exceeding service standard goals.
Retenion Specialist
Alorica
Davenport, IA
01.2014 - 05.2017
- Developed customer retention strategies to enhance client satisfaction and loyalty.
- Analyzed customer feedback to identify trends and areas for improvement.
- Trained team members on best practices for customer engagement and retention.
- Managed escalated customer inquiries, ensuring timely resolution and maintaining relationships.
- Handled escalated customer complaints professionally, de-escalating situations while finding mutually beneficial resolutions.
- Improved customer retention rates by developing and implementing personalized engagement strategies.
Education
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Skills
- I communicate well and can navigate multiple systems within UHC
- I can use excel, Microsoft word and adobe
- Data entry proficiency
- Strong analytical skills
- Medical terminology
- Insurance policies
- Teamwork and collaboration
- Critical thinking
- Policy review
- Coverage determination
- Financial transactions
- Patient contact
- Eligibility determination
- Denied claims identification
- Written communication
- Insurance coverage verification
Timeline
Case Prep Appeals Coordinator - UHC
11.2023 - Current
Appeals Representative - Clinical Appeals Closure Team
01.2022 - 11.2023
Customer Service Representative - Optum
05.2019 - 01.2022
Community And State Member Advocate - United Healthcare
03.2017 - 05.2019
Retenion Specialist - Alorica
01.2014 - 05.2017
Depue High School - ,
IVCC Illinois Valley Community College - ,