Sabina Ducasse

Reduced claim resolution time by conducting thorough investigations and timely decision making.

• Enhanced customer satisfaction through prompt communication and comprehensive claim explanations.
• Contributed to company growth by consistently meeting or exceeding productivity targets without sacrificing quality standards.
• Spearheaded process improvements that resulted in reduced backlog and faster claim settlements.
• Reviewed policy coverage details meticulously, ensuring accurate determination of benefits payable in each case.
• Streamlined claims processing by implementing efficient workflow procedures.
• Prepared detailed reports on claim activity for management review, highlighting areas for improvement.
• Researched claims and incident information to deliver solutions and resolve problems.
• Examined photographs and statements.
• Corrected codes to properly classify claims.
• Examined claims forms and other records to determine insurance coverage.
• Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
• Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
• Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
• Conducted day-to-day administrative tasks to maintain information files and process paperwork.
• Analyzed information gathered by investigation and reported findings and recommendations.
• Reviewed police reports, medical treatment records, and physical property damage to determine extent of liability.
• Identified suspicious losses and contacted manager for investigative assistance.
• Maintained claims data in computer systems.
• Established trust among clients by consistently delivering fair assessments of their insurance claims.
• Managed team of junior examiners, providing guidance and training for improved productivity.
• Directed claims negotiations within allowable limit and supported successful litigations for advanced issues.

• Handle Inbound and outbound calls for North Well Health Facilities
• Assist patients requesting information regarding doctor's appointments, health insurance information, prescription refills, etc
• Fulfills patient needs, resolves issues and ensures patient satisfaction
• Assists patients in making appointments for various clinical services
• Identifies specific patient needs to determine appropriate appointment type, location and urgency
• Obtains necessary demographic and insurance information and enters data into department computer system
• Verifies insurance coverage and other related data with third party carriers for scheduled appointments/procedures
• Determines if patient requires language interpretation, wheelchair and/or transportation accommodations and facilitates scheduling of services
• Communicates clear instructions and education related to scheduled services utilizing appropriate guidelines
• Facilitates appointment requests received through centralized online forum
• Uses procedures, policy manuals, knowledge-base and other reference materials to assist in answering various general inquiries and issues
• Triages specific and complex inquiries to appropriate resource
• Documents patient inquiries, issues, transactions and other relevant information into department computer system
• Identifies unusual events or consistent problem areas and addresses with management
• Suggests methods to simplify, enhance or update procedures
• Performs related duties as required
• (ADA Essential Functions)
• Secured patient information and confidential medical records in compliance with HIPAA privacy rule standards to protect patient's privacy.
• Ensured compliance with HIPAA regulations to maintain confidentiality of sensitive patient information during all interactions.
• Fielded telephone inquiries on authorization details from plan members and medical staff.
• Tracked referral submission during facilitation of prior authorization issuance.
• Verified eligibility and compliance with authorization requirements for service providers.
• Responded to inquiries from healthcare providers regarding prior authorization requests.
• Collaborated with physicians to obtain necessary clinical information for prior authorization submissions.
• Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.

• Triage new losses (auto, general liability, worker compensation and property claims)
• Assists management with new team member training
• Delegate tasks and set project deadlines
• Managing large amounts of inbound and outbound calls in timely manner
• Provides quality customer service, including interacting with customers, answering customer enquiries, and effectively handling customer complaints
• Enter and maintain required claim information into company claim system
• Review invoices and requisitions for satisfactory payment approval
• Check vendor files for any previous payments and assign voucher numbers
• Obtain proper information and/or data regarding invoice payments
• Conduct Claim Setup and Call Audits on Claims Intake Team
• Oversee triaging of work orders and distribution
• Assist prioritizing and follow-up on new claims requests
• Make sure that all claims are assigned correctly and setup in timely manner
• Handle escalated calls
• Assist in distribution of escalated calls to appropriate adjusters, teams, directors
• Train CSRs on claim handling questions, customer service advice and client procedures
• Provide claim question support on new setups.
• Consistently met or exceeded monthly performance metrics, including call quality scores and average handle times.
• Conducted regular performance evaluations for CSR team members, identifying areas of improvement and recommending targeted coaching plans.

• Operate telephone, switch board, screen and forward calls, provide information, messaging and scheduling appointments
• Manage reception area, greet visitors, direct and/or escort guests to specific destinations
• Keep current records of staff members’ whereabouts and availability
• Insert data and control staff clock ins and outs.
• Responded to inquiries from callers seeking information.
• Managed multiple tasks and met time-sensitive deadlines.
• Demonstrated strong multitasking abilities while managing numerous tasks simultaneously under tight deadlines.

• Answer phone calls and dispatch, Insert payrolls, send emails, fax, and clerical work
• Ensure officers and agents check in during dispatch.
• Sent out officers and agents to help assist hourly callers based on locations, needs and worker availability.
• Closely monitored dispatch board to triage and prioritize over daily calls.
• Managed high-stress situations calmly and effectively, ensuring timely assistance to those in need.
• Trained new dispatchers on company protocols, contributing to well-prepared team of professionals.
• Processed invoices and payments for dispatched orders to provide proof of transaction.

• Provide employees with great customer satisfaction
• Open/Close establishment on rotating schedule
• Balance cash drawers
• Train employees on register computer system
• Answer inquiries and resolve customer concerns.
• Applied strong leadership talents and problem-solving skills to maintain team efficiency and organize workflows.
• Improved customer satisfaction with timely response to inquiries, addressing concerns, and finding effective solutions.
• Evaluated employee performance and coached and trained to improve weak areas.
• Handled customer complaints, resolved issues, and adjusted policies to meet changing needs.
• Monitored workflow to improve employee time management and increase productivity.