Whitney Riley
Monroe,LA
Summary
Self-motivated Benefits Specialist demonstrating superior understanding of employee benefits laws and human resource software systems. Astute professional providing benefits support in fast-paced corporate settings. Collaborative individual with expertise in providing exemplary service regarding benefits support. Multitasking Benefits Specialist knowledgeable in state and federal regulations and maintaining employee confidentiality.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Case Review Specialist- Part Time Evenings
Trajector Disability
05.2024 - Current
- Filing appeals on client's disability claims
- Acting as a liaison between the Social Security Administration (SSA) and clients
- Collecting additional information from clients including medical treatment, employment information, and contact information to include in disability claim
- Educating clients with respect to claims' progress, deadlines, and needed information
- Assisting clients in completing needed paperwork and submitting to SSA
- Communicating with clients by phone, email, or text to provide information about claim, obtain details of complaints, and to request clients provide needed information to the Social Security Administration (SSA)
- Keeping records of interactions with clients and SSA offices including details of inquiries, complaints, comments, and actions taken
- Reviewing correspondence from client (letters, emails, texts, VMs) to determine information that is relevant to claim that needs to be shared with SSA
- Communicating with SSA offices by phone and fax to provide information about claim and obtain information regarding the claim including information SSA needs from client
- Checking to ensure client complaints are fully resolved or given to appropriate supervisors for further inquiry
- Recommending improvements in company service to increase efficiency and prevent future problems
- Actively engage in continued training.
Benefits Advocate
United Healthcare
10.2022 - 12.2023
- Verify insurance coverage for new patients and referrals, for claims process reconsideration utilized ICUE EMR to provide decision info on prior authorizations and medical records request for skilled nursing facilities hospitals etc
- Respond to and resolve, on the first call, customer service inquires and issues by identifying the topic and type of assistance the caller needs such as benefits, eligibility and claims, financial spending accounts and correspondence
- Help guide and educate customers about the fundamentals and benefits of consumer-driven health care topics to select the best benefit plan options, maximize the value of their health plan benefits and choose a quality care provider
- Contact care providers (doctor’s offices) on behalf of the customer to assist with appointment scheduling or connections with internal specialists for assistance
- Assist customers in navigating myuhc.com and other United Health Group websites and encourage and reassure them to become self – sufficient
- Assist customers with appeals processing denials, reviewed and submit prior authorization requests
- Review claims submitted by providers office for procedure codes and ICD 10 code information to confirm the claims were process with the correct diagnosis codes/icd for procedures billed
- If we found error notate and complete appeal and send to claims for reprocessing.
Remote Customer services Rep Medical Claims
CCC Info Services
03.2020 - 09.2022
- Receive initial calls and obtain all pertinent medical claim info /review eob with patients and providers
- Ensure Medical billing info was entered into the system correctly if not resubmit for correction
- Forward calls to adjuster dept for policy and coverage information and check issues
- Completed research and data entry for payment submissions for providers and patients while maintaining productivity and quality standards
- Provided claim info to callers such as billing status, payments issued on accounts provided claims handler info (Adjuster) routed them to the correct department for help with auto insurance policy info etc
- Answered all questions and explained the process pertaining to the medical portion of the auto claim
- Adhere to attendance, production, quality, and other metric standards
- Used EMR Medflow to review medical records for corrections/missing forms cms 1500 or UB-04 forms submitted with claim verified they had the correct coding if not sent request to provider requesting correct coding and diagnosis codes for claims processing.
Customer Service Representative
Nela Utilities/Water Company
07.2018 - 04.2019
- Answer and direct calls to the appropriate department
- Assist customers with billing issues
- Accounts Receivable/Post check payments to customer accounts
- Made sure the balances reflected correctly
- Created service orders to track issues with water, repairs, and sewer
- Processed incoming customer request
- Assist with customer complaints
- Completed 10 key on various assignments
- Performed Audits on credit card transactions
- Worked various projects for management
- Trained New Associates upon request
- Check company emails and responded.
Operations Specialist
JP MORGAN CHASE
04.2013 - 09.2016
- Document collections/Government Insuring
- Gathered customer information for loans
- Contacted title companies, Lenders and Closing attorneys for document requests etc
- Checked loans for errors made corrections as needed
- Worked to ensure the customers information was completed in a timely manner to
- Verified information to submit for government insuring, and insured loans
- Used 10 key to perform different data entry tasks
- Completed Audits on loan modification documents.
Education
Medical Administrative Assistant -Associate Degree -
Unitech Training Academy
09.2012
Graduate Diploma -
Wossman High School
05.2006
Skills
Communication
Benefits Administration
Customer service
Time management
Organization
Critical thinking
Insurance Verification
Verbal and written communication
Research abilities
Policy Knowledge
Benefits Explanation
Documentation And Reporting
Proficient in Microsoft suites and googles suites
Proficient in Hippa compliance procedures and guidelines
Accomplishments
Completed Case Management Certification 09/09/2024
Certification
09/09/2024, Certified Case Management Specialist
References
Upon Request
Certified Case Specialist
Complete and passed Test requirements to obtain Case management certification certificate
Timeline
Case Review Specialist- Part Time Evenings
Trajector Disability
05.2024 - Current
Benefits Advocate
United Healthcare
10.2022 - 12.2023
Remote Customer services Rep Medical Claims
CCC Info Services
03.2020 - 09.2022
Customer Service Representative
Nela Utilities/Water Company
07.2018 - 04.2019
Operations Specialist
JP MORGAN CHASE
04.2013 - 09.2016
Medical Administrative Assistant -Associate Degree -
Unitech Training Academy
Graduate Diploma -
Wossman High School
09/09/2024, Certified Case Management Specialist
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