Renee Wessel

Ensure all investigation, follow-ups, contacts, and all other claim handling accountabilities required for the full resolution of overpayment potential.

Process all payment reviews in a timely and compliant manner that is consistent with our quality standards.

Drive for a fair and equitable disposition which the customer understands.

Participate in the review and discussion of large overpayment reimbursement claims with management.

Participate in the development and presentation of overpayment reimbursement training materials to the field offices.

Coordinate additional investigations with the Ability Analysts in Group Benefits as needed.

Participate in and lead department projects.

Effectively and independently manages an assigned caseload of active claims, provides timely, balanced and accurate claim reviews, documentation and recommend decisions in a time sensitive and fast paced environment and in accordance with state and department of insurance regulations,

Provides frequent, proactive verbal communications with our claimants demonstrating empathy and active listening while providing clear updates, direction and explanations regarding the claim process, benefits and other pertinent plan provisions,

Interacts and communicates effectively with claimants, customers, health care providers, attorneys, brokers and family members during claim evaluations, compilers file documentation and correspondence, analyzes information to determine if additional information is needed to make a reasonable and logical claims determination,

Collaborates effectively with both external and internal resources, such as physicians, clinical and vocational consultants and attorneys to gather medical information to ensure reasonable, thorough decision, proficiently calculates monthly benefits due after the elimination period to include COLA, Social Security offsets and return to work benefits,

Provides timely and detailed written communication, addresses and resolves escalated customer complaints in a timely and thorough manner.

Effectively and independently manages an assigned caseload of active claims, provides timely, balanced and accurate claim reviews, documentation and recommend decisions in a time sensitive and fast paced environment and in accordance with state and department of insurance regulations.

Provides frequent, proactive verbal communications with our claimants demonstrating empathy and active listening while providing clear updates, direction and explanations regarding the claim process, benefits and other pertinent plan provisions.

Interacts and communicates effectively with claimants, customers, health care providers, attorneys, brokers and family members during claim evaluations.

Compilers file documentation and correspondence, analyzes information to determine if additional information is needed to make a reasonable and logical claims determination,

Collaborates effectively with both external and internal resources, such as physicians, clinical and vocational consultants and attorneys to gather medical information to ensure reasonable, thorough decision,

Proficiently calculates weekly benefits due after the elimination period

Provides timely and detailed written communication, addresses and resolves escalated customer complaints in a timely and thorough manner.

Staffs, trains, and develops department personnel.

Establishes work procedures and standards to improve efficiency and effectiveness of the staff.

Examines workflow and processes as needed to promote operational excellence.

Ensures seamless coverage and support for the operation.

Performs various advanced administrative duties for assigned leader, including the head of a business unit, with accuracy and timeliness.

Allocate work and coordinate delivery of small local projects or sub projects to ensure that the overall project objectives are clearly defined and met, and business benefits are delivered.

Ensure our Standard operating procedures are beginning followed and our KMT metrics are being met through quality and timeliness audits.

Contribute to the development of our supplier resources by participating in the creation and presentation of training.

Improve efficiencies through process improvements and simplification efforts, conduct regular audits documenting errors and identifying opportunities for improvement.

Investigating and resolving issues quickly and efficiently and ensuring our supplier team is in compliance and following Operations Best Practices in all tasks they complete for Administration and Operations through monthly secondary audits and reviews and updates to our Standard Operating Procedures.

Greets internal and external customers, handles inquires, and resolves issues and complaints. Directs to appropriate staff as needed.

Received and processed incoming medical service requests for Worker’s Compensation claims for our Nurses and Physicians to review within our jurisdictional turnaround time.

Identified errors in Physician responses that were missed by our reviewing MD or RN and ensured they were fixed promptly and escalated when necessary.

Trained all new incoming hires and current staff on how to complete UR Closures, Reconsiderations and Appeals.

Created new committees which I co-lead with the goal of engaging our whole department in fun team building activities inside and outside of work.

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Received and accurately processed prescriptions from patients and physicians using RxEVO computer systems.

Worked closely with our Pharmacy Care Representatives in providing excellent patient care, effectively resolved insurance rejections and other billing issues.

Preformed technical processes required to dispense medication to patients, managed supply procurement and management processes, and completed and updated patient profiles, including lists of patient medications and drug allergies.