VATYNA S. GRAY

Evening shift

• Collaborated with cross-functional teams to gather necessary documentation for appeals.
• Facilitated communication between members, providers, and internal departments regarding appeals.
• Reviewed and assessed case files to ensure accuracy and completeness of information.
• Utilized case management systems to track, manage, and document appeal processes efficiently.
• Developed detailed reports on appeal trends to support process improvement initiatives.

Company Overview: formerly Meridian Health Plan

Morning shift

• Over 10+ years in the health care plan space with experience in healthcare compliance and patient advocacy.
• Skilled in conducting thorough research and investigations of to identify potential resolutions in a timely manner.
• Proven track record of maintaining accurate documentation and reporting outcomes to improve overall processes.
• Proficient in analyzing complex case files to ensure compliance with regulatory standards and organizational policies.
• Experienced in using data analytics to identify trends and recommend improvements in grievance resolution.

Company Overview: contracted To LinkedIn

• Experienced content moderator with a proven track record in ensuring compliance with community guidelines and standards.
• Assist online platform's/online communities establish their credibility and safely provide real-time protection for users by removing inappropriate, potentially harmful content before it reaches the users, and identify fraud
• Responsible for taking action to remove or flag content that violates the platform's policies or is inappropriate or offensive
• Reviewing and evaluating content through extensive research that is posted on a platform to ensure that it complies with the platform's policies and guidelines
• Proficient in utilizing moderation tools and software to streamline the content review process.

• Skilled in coordinating cross-functional teams to develop and implement effective strategies for appeal resolutions.
• Provided expertise and knowledge on all facets of legislative, regulatory, ethics, and benefit/plan compliance while promoting process improvements for efficiency
• Completed in-depth investigations into issues pertaining to grievances and performance time constraints met
• Provided direct leadership and oversaw bi-weekly meetings, prepped summaries for committee review, participated in interdisciplinary meetings, and communicated decisions in writing
• Strong communicator, adept at liaising with internal stakeholders, external partners, and regulatory bodies.