Vanaequa Malave Guzman

• Coordinated patient intake process, ensuring all required documentation was complete and accurate
• Verified patient information, insurance eligibility, and benefits prior to services
• Reviewed intake documentation for accuracy and compliance with company standards
• Communicated with patients, and internal teams to gather and confirm required information
• Entered and maintained patient records in internal systems with a high level of accuracy
• Assisted in ensuring timely processing of patient admissions and services

• Investigated and resolved client-reported fraud claims with a focus on accuracy and compliance.

• Reviewed financial transactions, analyzed claim details, and escalated findings when appropriate.

• Collaborated with internal departments to assess risks and ensure quality customer service.

• Documented findings and maintained detailed records in internal CRM systems.

• Managed high-volume call handling, responding to over 90-100 customer inquiries daily.

• Verified member eligibility, benefits, and coverage related to services
• Reviewed documentation to ensure accuracy and alignment with coverage guidelines
• Assisted in resolving authorization-related discrepancies and escalations
• Reviewed prior authorizations to determine approval or denial status
• Explained authorization decisions to members, including reasons for denials or approvals
• Demonstrated strong communication skills while interacting with members over the phone, via email, or in person.
• Assisted with training new employees on the company’s procedures for handling member inquiries.
• Employed active listening techniques to understand customers’ needs and provide appropriate solutions.
• Handled escalated calls professionally while providing a positive resolution for the caller.
• Educated member on benefit enrollment choices and what each plan offers.
• Scheduled yearly wellness visit for member.
• Investigated prescription refill denials.

• Verified member eligibility, benefits, and coverage related to services
• Reviewed documentation to ensure accuracy and alignment with coverage guidelines
• Assisted in resolving authorization-related discrepancies and escalations
• Reviewed prior authorizations to determine approval or denial status
• Explained authorization decisions to members, including reasons for denials or approvals
• Demonstrated strong communication skills while interacting with members over the phone, via email, or in person.
• Assisted with training new employees on the company’s procedures for handling member inquiries.
• Employed active listening techniques to understand customers’ needs and provide appropriate solutions.
• Handled escalated calls professionally while providing a positive resolution for the caller.
• Educated member on benefit enrollment choices and what each plan offers.
• Scheduled yearly wellness visit for member.
• Investigated prescription refill denials.