Passionate customer service professional with 10+ years experience in a range of dynamic, high-volume environments.
• Ensures legal compliance by following company policies, procedures, and guidelines, as well as state and federal insurance regulations.
• Applied medical necessity guidelines, determine coverages, complete eligibility verification, identify discrepancies and apply all cost containment measures to assist in the claim adjudication process.
• Coordinate response for routine phone inquiries and written correspondence related to claims processing.
• Act as point of contact for providers and beneficiaries when inquiring about claims status/benefits.
Utilized all applicable system functions available ensuring accurate and timely processing of claims.