QuaShanna Montgomery
Garfield
Summary
Dynamic insurance professional with proven success in high-pressure environments. Expertise in claims adjustments, specializing in auto appraisals and CCC pathways estimations. Strong analytical skills and a commitment to delivering results efficiently.
Overview
8
8
years of professional experience
1
1
Certification
Work History
UM Appeals Analyst- UMAC
Horizon BCBS of NJ
Newark
05.2023 - 03.2025
- Resolved an average of 25 Medicaid and Medicare appeal tickets daily via phone, email, and live chat.
- Achieved a 100% customer satisfaction rating based on post-interaction surveys.
- Trained and mentored new hires on service protocols and internal tools, enhancing team efficiency.
- Identified and escalated recurring issues, leading to an 85% reduction in repeat inquiries.
- Maintained strict HIPAA compliance when handling PHI during calls and documentation.
Managed Care Coordinator I – Prior Authorization
Horizon BCBS of NJ
Newark
10.2019 - 04.2023
- Managed inbound and outbound customer calls for Medicaid behavioral health, addressing concerns within service level agreements.
- Processed prior authorization requests in compliance with HIPAA and Medicaid guidelines.
- Exceeded individual performance metrics in call resolution time and customer satisfaction scores through collaboration with team leads on service improvements.
- Processed 40+ behavioral health prior auth requests daily, reducing turnaround time by 30%.
- Resolved billing disputes by collaborating with internal departments and maintaining professionalism under pressure.
Lead Clinical Service Associate
Beacon Health Options
Roseland
06.2018 - 12.2019
- Resolved over 100 daily inquiries via phone, email, and live chat, achieving a 95% customer satisfaction rate.
- Mentored and trained new employees on CRM systems, Medicaid and Medicare guidelines, and customer interaction protocols.
- Analyzed service feedback to enhance processes, reducing response times by 15% and maintaining SLA compliance above 98% with the use of Zendesk.
Information and Referral Specialist
First Call for Help NJ/NJ211
Whippany
09.2017 - 06.2019
- Managed over 100 calls daily in a dynamic call center, consistently achieving a customer satisfaction score exceeding 90%.
- Conducted comprehensive needs assessments to accurately identify client requirements and provide suitable referrals.
- Collaborated with community partners to enhance referral processes and improve client outcomes, while maintaining detailed and confidential case records.
Education
Bachelor of Arts - Psychology
William Paterson University of NJ
Wayne, NJ05-2016
Skills
- Customer service and support
- Conflict resolution
- Call center operations
- CRM management
- Order processing
- Technical troubleshooting
- Communication skills
- Time management
- Data entry
- Performance metrics
- Microsoft Office Suite
- Google Workspace
- Zendesk and Freshdesk
- Salesforce and HubSpot
- LiveChat support
- Collaboration tools (Slack, Teams, Zoom)
- Remote desktop assistance
Certification
- Customer Service Excellence Certificate, Horizon BCBS of NJ, 2023
- Conflict Resolution Training, Horizon BCBS of NJ, 2020
- Salesforce/Zendesk CRM Training, 2023
Timeline
UM Appeals Analyst- UMAC
Horizon BCBS of NJ
05.2023 - 03.2025
Managed Care Coordinator I – Prior Authorization
Horizon BCBS of NJ
10.2019 - 04.2023
Lead Clinical Service Associate
Beacon Health Options
06.2018 - 12.2019
Information and Referral Specialist
First Call for Help NJ/NJ211
09.2017 - 06.2019
Bachelor of Arts - Psychology
William Paterson University of NJ
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