Tiara McDaniels

• Assisted with crisis intervention to de-escalate challenging behavior and maintain peaceful encounters.
• Facilitated social outings and community integration activities, promoting inclusion and positive experiences for clients.
• Encouraged and supported clients to participate in recreational and leisure activities to promote social interactions and reduce loneliness.
• Assisted individuals with daily living activities, promoting independence and personal growth.
• Developed and implemented individualized care plans to meet diverse needs of clients.

Coordinated with over 5 health insurance providers.

Enhanced understanding of consumer-driven health topics.

Delivered exceptional service to pinpoint root causes of issues.

Addressed customer issues efficiently related to:

- Correspondence Requests

- Medical Eligibility and Claims

-Submissions , Reviews and Approval for Prior Authorizations from Providers and Members

- Pharmacy Benefits , Eligibility and Claims

• Led navigation teams to enhance patient engagement and care coordination.

Composed verbal grievances, appeals, and coverage determinations following Medicare regulations.

• Established strong connections and trust with callers while sharing educational plan information.
• Proficient Medical Claims and Billing,
• Insure accuracy of all Insurance Claims submissions for both Prescriptions and Medical
• Streamlined authorization processes to enhance efficiency and reduce turnaround times.
• Coordinated communication between clinical teams and providers to ensure accurate information flow.

• Cultivated strong relationships with diverse clientele through empathetic communication and active listening during challenging circumstances.
• Attended training sessions focused on current industry trends and best practices to elevate customer service delivery.
• Elevated customer satisfaction by effectively resolving issues and addressing concerns.
• Facilitated member inquiries, providing accurate information and resolving issues efficiently.
• Coordinated benefits enrollment processes, ensuring compliance with regulations and company policies.