Pamela McCool

Assist members in resolving issues or complaints in a timely manner.
Processed applications, renewals, and cancellations of membership accounts efficiently. Engaged in conversation with customers to understand their needs, resolve issues, and answer product questions. Provide outstanding member service to clients by answering questions, resolving issues, and explaining insurance policies and procedures related to coverage and benefits.

Served as lien resolution subject matter expert in complex cases with affective lien resolution Provided strategic support to determine the best resolution path for new high-profile programs, which allowed most claimants access to a portion of their settlement funds while liens were being resolved. Fostered collaborative relationships with lienholder, subrogation vendors, and government contacts. Organized client meetings to provide project updates. Effectively communicated and collaborated with internal data services and client service teams to process data and provide timely updates to clients on cases. Identified and resolved problems through root cause analysis and research. Implemented strategies for automating manual processes within the organization.

Organized workflow to ensure all orders were processed accurately and on time. Conducted regular training sessions for new hires on order fulfillment systems and procedures. Monitored performance metrics such as turnaround times, fill rates, accuracy rates. Ensured accuracy of orders prior to shipping by verifying the quantity, product type, and address information. Analyzed data from reports to identify areas of improvement in order processing efficiency. Created detailed reports summarizing operational performance against established goals. Developed strategies for efficient order fulfillment processes and procedures.

Deliver exceptional customer service on all calls while maintaining calm and professional demeanor in challenging circumstances
Conduct investigations into complicated mid- and high level-exposure claims
Improved team productivity by providing ongoing training and support to junior claims representatives.
Reduced backlog of pending claims by introducing an effective triage system based on priority levels.
Analyzed complex claims data, identifying trends, and recommending improvements to reduce future risks.
Collaborated with legal and medical professionals to gather necessary information for claim assessment.

• Assisted in the development of new provider programs and initiatives Resolved conflicts between providers and payers through effective communication strategies. Participated in negotiations with providers concerning the terms of service agreements. Facilitated dispute resolution processes between payers and providers utilizing effective problem solving techniques. Researched and resolved issues related to provider contracts, credentialing requirements, and reimbursement claims. Investigate and resolve outstanding overpayments.

• Reviewed and processed customer invoices for accuracy. Assisted in the preparation of monthly financial statements. Researched and resolved billing issues with customers. Maintained records of all customer transactions and payments. Prepared weekly, monthly, quarterly, and annual reports on billing activity. Managed customer account setup process including creating new accounts as needed. Identified areas where efficiency could be improved within the billing department. Monitored outstanding receivables and followed up on late payments as required. Provided support during internal and external audits related to billing processes.