Randi Wood

As part of the Legal Escalations Team, I provide legal case management support for Elevance Health's Legal Departments on the west and east coast.

• Serving as Case Manager for pre-litigation, arbitrations, settlements, and demands.
• Creating DLPs, process documentation, training materials, and mentoring both interdepartmentally and cross-departmentally.
• Production of Excel Waterfall Reports.
• Monitor and resolve issues through proactive Denial Management, internal collaboration, and provider education.
• Reduce and mitigate legal and regulatory fines through timely resolution.
• Retrieving and handling claim-related documentation, including medical records, claim images, EOB/Remits, correspondence, PDRs, and appeals.
• Managing claim researchers and overseeing deadlines, as well as coordinating meetings with general counsel and outside counsel.
• Project Manager for WGS BOT Automation and Health Solutions IDR CMS Automation.
• CURES Yellow Belt Certification
• Cultivated positive rapport with fellow employees to boost company morale and promote employee retention through the Employee Engagement Committee.

I am experienced in customer service, adjustments, and the manual reprocessing of medical claims. I analyze claims issues and provide key information and solutions to providers, management, and plan-to-plan contacts. I assist managers with high-priority reports focusing on aged inventory while collaborating interdepartmentally and cross-departmentally to reduce inventory, assist on projects, manage escalations, and implement best practices.

• Supervisor Back-Up.
• Trained on LDLA Data & Financial Errors.
• Primary Trainer & Auditor for our oversea employees on the manual reprocessing of claims.
• Worked productively in fast-moving work environment to process large volumes of escalated provider requests.