Theresa Horne

• Processed and finalized appeals and grievances within agreed-upon turnaround time.
• Remained knowledgeable regarding company policies and procedures and current developments within operational departments.
• Submitted verbal and written notification to members and providers.
• Demonstrated high-level attention to detail when reviewing medical records, provider contracts, and other relevant documents during case assessments.
• Enhanced internal processes for handling complaints by developing standardized guidelines and documentation templates.
• Maintained strict confidentiality of sensitive member information while adhering to HIPAA regulations during case investigations.
• Expedited resolution times by proactively communicating with members, providers, and other stakeholders throughout the grievance process.

Spoke with providers through inbound calls answering inquiries about member's coverage and validating information.

Trained in claims and benefits in Health Rules and ISET.

Represented Medica, providing the first point of contact for providers to communicate regarding the accuracy and timeliness of claims payments, referral procedures, prior authorization procedures, appeal procedures, product information, benefit verification and general plan information.

Reached out to members in a couple outside projects. One was to help member's on Medicare understand the insurance changes as the Pharmacy Benefit Manager changed to Express Scripts. Another was to reach out to those that had recently been afflicted with Covid19 to help provide information and see who they had contact with.

• Maintained cash and personal records with accuracy and efficiency.
• Count and record each register's receipt at the end of the business day.
• Showing high attention to detail while accurately recording date for the store's records.
• Reconcile and secure all store funds.
• Assist customers with in-store inquires and provide information on products.

• Built broadcast storylines to interest listeners and grow station audience.
• Engaged with audience members through telephone calls and personal commentary on musical selections, political happenings and other items of interest.
• Spearheaded promotional appearances on behalf of station and to increase sales for advertisers.
• Delivered exceptional programming to audience members by always researching events, guests and programs thoroughly.
• Informed audience about local events, general PSAs and music titles and artists.

• Recorded ads and commercials for local businesses, edited cuts and aired results on strict schedules.
• Offered friendly and efficient service to all customers, handled challenging situations with ease.
• Maintained excellent attendance record, consistently arriving to work on time.
• Managed all daily news announcements and scripted quick headlines for breaking news events.
• Informed audience about events, general PSAs and music titles and artists.