Victoria Adams

• Gathered applicant's documentation to analyze for eligibility criteria . Standard of three outreaches to retrieve necessary documents, 20day timeline to review and create case, or disqualify. Phoned, emailed, and SMS text to communicate requirements and processes to applicants. Reviewed case load of 300 applications monthly, Met, and exceeded production metrics. Evaluated, and obligated amount of aid, or contact applicants with review outcome. Fast paced, and evolving. Understood program objectives, requirements and procedures and communicated these effectively.

Automated Call Distribution dispatched calls I answered within 30 seconds, mandatory opening, and closing format. Calls for explanation of benefits for Union and private employee's from multiple States. Billing inquiries became ownership until they were resolved by escalation or resolved and communicated to the member by email within 3 days. Authorizations for surgery and specialized Doctor visits processes explained, and created. All calls were reviewed and graded for accuracy of the information provided had to meet the operating standards. Maintained a working knowledge of policy and procedures from State to State.

• Kept accurate records to document customer service actions and discussions.

Analyzed book of business of 350 existing policies with predetermined documentation. At times worked with Upper Management to interpret and evaluate alternative documents to gain objective of review. Used documents to access if client purchased correct policy for their demographic. Review was time sensitive and was done at renewal period so timeline was essential. Annotated documents and communication in system of record. Utilized underwriter records to factor and ensure accurate review determination of policy renewal or cancelling of policy. Each file was quality assured to maintain accuracy. PHI HIPAA standard operating procedure adhered.