Summary
Overview
Work History
Education
Skills
Additional Information
Timeline
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Raymonisha Van

Baton Rouge,LA

Summary

Resolution Coordinator and Customer Service experience with over 6+ years of experience, excelling in analytical abilities and Microsoft Office Proficiency. Expertise in analyzing customer needs to ensure high satisfaction and loyalty, demonstrated through strategic problem-solving that significantly reduces complaints and enhances customer retention. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Skilled in customer relations, maintaining high levels of service and effective communication to foster strong relationships and ensure consistent customer satisfaction.


Overview

6
6
years of professional experience

Work History

Resolution Coordinator

Lowes Home Improvment
04.2021 - Current
  • Manage a high volume of incoming calls from customers, stores, and associates while navigating multiple systems to aid in answering questions and resolving issues.
  • Conducted research, gathered information from multiple sources to process claims and to resolve CRMs from basic ro complex situations on a daily basis either to pay or deny medical claims based upon established claims processing criteria, guidelines , and procedures.
  • Reviewed and re processed denied claims from different reports in addition to regular claim processor criteria mentioned in previous position.
  • Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.




Claim Examiner

Blue Cross Blue Shield Of Louisiana
07.2018 - 03.2021
  • Reviewed, analyzed, investigate, and processed all types of medical and transplant claims by following procedures and guidelines.
  • Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.
  • Directed and coordinated various investigations conducted by Payment Integrity Team.
  • Prepared material for audits and provided assistance to lead and Supervisor during audits.
  • Handled high dollar and transplant cases and made recommendations to ensure appropriate and timely claims payments.
  • Referred eligibility, authorization, benefits,and pricing information to determine appropriate course of action(i.e. claim reject/denial, request for additional information, request for refund. etc.)

Education

High School Diploma -

Zachary High School, United States
Zachary, LA
05.2018

Skills

  • Call center experience
  • Analytical abilities
  • Planning and coordination
  • Responsible
  • Interpersonal Communication
  • MS Office
  • Good listening skills
  • Collaboration
  • Team management
  • Training & Development
  • Reading comprehension
  • Professional ethics understanding

Additional Information

Reference will be provided upon request

Timeline

Resolution Coordinator

Lowes Home Improvment
04.2021 - Current

Claim Examiner

Blue Cross Blue Shield Of Louisiana
07.2018 - 03.2021

High School Diploma -

Zachary High School, United States

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Raymonisha Van