Regine Nemorin

Address all authorization requests properly within set timelines.

Researched and documented required medical information including history, diagnosis, and prognosis for clinical reviewer determination.
Confirmed member insurance coverage and service eligibility through system tools.
Entered and updated various authorization requests into the utilization management system.
Routed service authorization requests to appropriate clinical reviewers.
Updated knowledge on healthcare, authorization processes, policies and procedures.
Executes additional tasks as directed.

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first-line advocate that focused on resolving inquiries, issues, or concerns for members and/or providers. Leverages a variety of communication channels to provide members and/or providers with timely, accurate, and personalized support on routine complaints.Received and responded to routine member and/or provider inquiries, requests and/or concerns in an accurate and timely manner
Mitigate and prevents complaints from being escalated to resolve in initial contact
Served as the front-line resolution advocate on various member and/or provider inquiries, requests, or concerns
Resolve basic problems by communicating the requested information regarding the assessment of the member or provider needs, understanding the cause, and determining if problems need to be routed to other departments for further resolution
Maintain performance and quality standards based on established contact center metrics
Provide customer service in a high pace contact center environment over the phone, via live chats and emails
Document all member or provider information and communications for quality and performance tracking through the Customer Relationship Management applications
Remain up-to-date and adheres to quality standards, regulation, and all other policies to ensure quality, consistency, and compliance

• Delivers exceptional customer service in a fast-paced contact center environment.
• Performs telephonic outreach to members for quality improvement.
• Coordinated transportation for members requiring assistance.
• Recorded all activities related to member communication.
• Collaborates with various departments, including customer service, to address member issues.
• Executed special assignments crucial to departmental operations.

• Educated clients regarding details of auto loans and warranty options.
• Handled and resolved customer grievances effectively.
• Handled the processing of forms for credit approvals.
• Recorded detailed information for each call.

• Resolved customer inquiries via telephone and written correspondence in a timely manner…
• Provided assistance to members and or providers regarding registration
• Guided healthcare participants through Health Plan processes.
• Maintained records of all documented activities.

• Ensured accurate patient registration and insurance verification.
• Gathered necessary data to file claims.
• Collaborated with insurance companies, healthcare providers, and patients to facilitate claim processing.
• Resolved patients' billing inquiries.
• Analyzed and disputed non-paid claims.
• Managed collections for unpaid accounts.

• Authorized charges against customers' accounts
• Handled complaints concerning merchandise, services, billing, and warranty repairs.
• Communicated adjustments based on investigative results to clients.
• Conducted follow-ups with customers to confirm satisfaction.