Royale Cocanougher

Regularly maintain connection with various providers via email and monthly calls to assist with escalated overpayment disputes.

Prevent future escalations by thoroughly researching disputes, reviewing data and contacting essential departments for resolution.

Using root cause analysis research claim overpayment with over 5 tools at a time to provider detailed resolutions.

Processed claims, refunds and adjustments for Medicare members and providers.

Researched claims to evaluate correct payment while maintaining and exceeding daily goals.

• Followed all company policies and procedures to deliver quality work.
• Improved customer satisfaction rates through proactive problem-solving and efficient complaint resolution.
• Interpreted member needs and introduced services to fit specific requirements.
• Worked under strict deadlines regarding members who wanted to disenroll from their current medical or prescription plans that are regulated by The Center for Medicare and Medicaid Services.