Jacquelyn L Van Der Horst
Cleveland
Summary
Knowledgeable Customer Service Specialist with a solid background in eligibility determination and case management. Adept at managing complex cases and ensuring compliance with regulatory standards. Demonstrated effective communication and problem-solving skills in high-pressure environments.
Overview
13
13
years of professional experience
Work History
Medicare Eligibility Specialist
Centauri Health Solutions
09.2019 - Current
- Conducted detailed interviews with applications to determine their eligibility for assistance programs.
- Processed client applications in accordance with established guidelines.
- Answered questions and responded to inquiries to deliver a high level of service to patients.
- Developed strategies to improve efficiency in the processing of applications and customer service delivery.
- Gathered financial information from clients regarding income, assets, and debts.
- Ensured compliance with local, state, and federal regulations during all phases of the eligibility determination process.
- Increased accessibility for non-English speaking applicants by developing and implementing multilingual support system.
Claim Appeal Senior Representative
United Healthcare
01.2016 - 03.2018
- Research and resolve written complaints submitted by consumers and physicians/providers.
- Ensure complaint has been categorized correctly.
- Obtain additional documentation required for case review.
- Render decision for non-clinical complaints using sound, fact-based decision making.
- Complete necessary documentation of final appeals or grievance determination using appropriate templates.
- Communicate appeal or grievance information to members or providers and internal/external parties within the required timeframes.
Pharmacy Benefit Representative /Private Label
Express Scripts
07.2013 - 11.2016
- Assist members with ordering medications and provided estimated ship dates
- Assist customers and doctors representatives with claims information.
- Average calls per day consist of 90 daily with an average talk time of 2-3min per call
- Maintained a high quality score of an average of 95%
- Assist Retail pharmacies with pharmacy overrides and explaining rejection codes
- Assisted members with an explanation of their insurance plan.
- Provide Web assistance such as navigation and password reset.
Senior Customer Service Representative
United Healthcare Group (Aerotek Staffing)
01.2012 - 01.2013
- Responsible for answering incoming calls from customers while insuring a high level of customer service and maximizing productivity.
- Resolving customer inquiries which include claims, billing and payments and reimbursements.
Education
Hondros College
Mentor, OHundefined
United States Army
Fort Jackson, SCundefined
Southern Ohio Buckeye
Cleveland, OHundefined
Kent State University
Kent, OHundefined
Eerieview Catholic High School
Cleveland, OHSkills
- Customer service
- Data entry
- Computer skills
- Office administration
- Microsoft Excel
- Active Listening
- HIPPA compliance
- Client Support
Timeline
Medicare Eligibility Specialist
Centauri Health Solutions
09.2019 - Current
Claim Appeal Senior Representative
United Healthcare
01.2016 - 03.2018
Pharmacy Benefit Representative /Private Label
Express Scripts
07.2013 - 11.2016
Senior Customer Service Representative
United Healthcare Group (Aerotek Staffing)
01.2012 - 01.2013
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United States Army
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Southern Ohio Buckeye
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Kent State University
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Eerieview Catholic High School
Hondros College
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