Tannette Russell

Appeals and Medical Review Specialist

• Managed comprehensive appeals process including document assignment, data research, and coordination of medical reviews for presentation to review committees
• Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
• Conducted thorough research utilizing internal databases and external sources to support evidence-based appeal determinations
• Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
• Maintained meticulous documentation of case progression and outcomes while ensuring compliance with regulatory timeframes
• Responded to customer requests for products, services, and company information.
• Collaborated with policy teams to implement and communicate procedural updates across departments
• Enhanced customer satisfaction by promptly addressing concerns and providing accurate information.
• Prioritized urgent appeal reviews to meet critical deadlines and prevent regulatory penalties
• Maintained detailed records of customer interactions, ensuring proper follow-up and resolution of issues.
• Served as primary point of contact for provider and member inquiries regarding policies, procedures, health plan information, and claims status
• Collaborated with team members to develop best practices for consistent customer service delivery.
• Facilitated clear understanding of complex healthcare policies and procedures for both providers and members
• Executed timely distribution of sensitive and time-critical documentation to appropriate stakeholders
• Demonstrated exceptional professionalism in addressing and resolving provider and member concerns
• Maintained strict HIPAA compliance in all communications and documentation handling
• Consistently met stringent regulatory timeframes to ensure organizational compliance and avoid financial penalties
• Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
• Developed strong product knowledge to provide informed recommendations based on individual customer needs.
• Developed rapport with customers through active listening skills, leading to higher retention rates and positive feedback from clients.
• Assisted customers in navigating company website and placing online orders, improving overall user experience.
• Provided coaching and mentoring to new hires, contributing to their successful integration into the team.
• Resolved escalated customer issues, restoring confidence in company's commitment to service excellence.
• Addressed customer inquiries to ensure satisfaction and foster positive service experience.
• Maintained detailed records of customer interactions, contributing to comprehensive database for future reference.

Member Services Representative | Regence Blue Shield

• Provided comprehensive customer support through multiple communication channels including LiveHelp Chat, email correspondence, and inbound call center operations
• Served diverse clientele across multiple insurance groups and plan types, delivering consistent, high-quality service
• Provided exceptional customer service, resolving complaints and answering queries promptly.
• Expertly addressed complex inquiries regarding claims processing, benefit interpretation, eligibility verification, and plan specifications
• Executed timely distribution of confidential documentation to members and healthcare providers, prioritizing materials with regulatory deadlines or urgent clinical implications
• Gained and maintained department product knowledge to facilitate customer service.
• Demonstrated exceptional problem-solving skills when resolving member and provider concerns, maintaining professional demeanor during challenging interactions
• Ensured strict adherence to HIPAA regulations and privacy protocols in all communications and documentation handling
• Maintained thorough documentation of all member and provider interactions to ensure continuity of service and compliance with organizational standards
• Consistently met or exceeded performance metrics for call resolution time, customer satisfaction, and accuracy of information provided
• Collaborated effectively with internal departments to expedite resolution of escalated issues and ensure comprehensive service delivery
• Assessed and resolved customer service problems and executed solutions.
• Managed specialist team to provide technical assistance and customer service.
• Provided exceptional customer service, resolving client issues efficiently and effectively.
• Provided excellent customer service while meeting challenging time goals.
• Resolved customer service issues related to pricing or discounts.
• Managed high call volume while maintaining exemplary customer service standards.

Seasonal Jan 2-Apr 20th each year Customer service:

• Managed comprehensive front office
• Provided expert triage services for tax-related inquiries
• Maintained efficient office workflow
• Processed accounts receivable transactions
• Executed document management responsibilities
• Maintained strict compliance with HIPAA and Personal Information (PI) protection protocols
• Performed essential office maintenance duties
• Welcomed new and returned clients while efficiently managing office duties
• Utilized strong organizational skills