Ciera Reed

• · Manage large volume of disability claims.
• · Apply contract/policy knowledge to ensure appropriate eligibility requirements, liability decisions and appropriate payee.
• · Follow up with claimants to verify their disability and request information as needed.
• Produce objective, clear documentation and technical rationale for all claim determinations and demonstrate the ability to effectively verbally communicate determinations.
• Provide timely and excellent customer service by paying appropriate claims promptly and quickly responding to inquiries.
• Maintain expected service and quality standards on all assigned claims.

• · Research and navigate various documents and databases in order to accurately process claims
• · Review benefits and eligibility to ensure that claims are processing toward the correct benefit
• · Review Coordination of Benefits information
• · Evaluate authorization information in order to apply correctly to claims
• · Utilize multiple computer systems/applications simultaneously

• Coordinated patient appointments and follow-up communications to enhance patient experience.
• Managed patient inquiries, resolving issues promptly to ensure satisfaction.
• Assisted healthcare providers with administrative tasks, streamlining workflows and improving efficiency.
• Educated patients on services and procedures, fostering informed decision-making for care options.

· Handle all requests from providers in a timely manner including predeterminations, provider reconsiderations and appeals, and medical records requests

· Investigate medical claim questions and adjust as needed to ensure accurate processing per the members benefits and provider contract

· Maintain daily and monthly productivity goals by managing time appropriately and completing applicable time reporting

· Review inquiries routed to research from Customer Service staff and respond appropriately

• · Deliver excellent customer service to providers and ensure their needs are resolved in a timely manner
• · Excellent attention to detail skills to guarantee every member’s unique information is provided accurately
• · Partner with appropriate resources when questions arise to obtain appropriate course of action
• · Keep providers apprised of any open inquiries
• · Ensure every routed inquiry has been sent to the correct department for timely and accurate review