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Click here or scroll down to respond to this candidateL/YLATOYAYARBROUGHContact PHONE NUMBER AVAILABLEEMAIL AVAILABLECharlotte NCProfileMeticulous professional, recognized for dedication to providing comprehensive service to clients, encompassing thorough evaluation of needs to recommend the best auto shops. Looking to build a strong career with aiding clients with insurance premiums, coverages, and claims informationExperienceAllstate Insurance (Work from Home)Senior Claims Processor Charlotte NC2/2019 to CurrentProcess FNOLs handle high volume of inbound and outbound calls and chat lines, work with auto, property and medical claims; assesses damages, make payments, and ensures claim determine whether the insurance policy covers the loss claimsDecide the appropriate amount the insurance company should pay. Ability to overcome sales objections when advertising Allstate repair shop working a fast-paced environment handling all customers concerns and inquiries Verify accident facts, determine policy coverage, and review insurance contractsAssist in settling claims where there are no injuries, and all parties agrees to the accident Manages mid-level general liability claims by gathering information to determine liability exposure, making claims payments as necessary, and settling claims up to designated authority level.LEAP Energy Assistance ProgramCaseworker Metro Staffing 12/2018 February 2019Provided clerical support in the delivery of Fuel Assistance Program to low-income residents calculate wages to see if client is eligible for services of Mecklenburg County, completed all forms that associated with the LEAP ProgramGathered clients personal information and entered data into NCFAST. Knowledge of OLV,SDX, ACTS and Bendex. Made Inbound/outbound calls to follow up with client application. Maintained confidential information adhered to PHI and HIPPA laws knowledge of NC state Program and guidelines. Interviewed customers for eligibility status while educating about the programBROAD PATH HEALTHCARE SOLUTIONS (WORK FROM HOME) PROVIDER RELATIONS / CLAIMS BILLING AND IT/ SPECIALIST 11/2016 -12-2018 CONTRACT ASSIGNMENTSR Virtual Team leader to staff of 140 associates via skype and B-hive Supported the leadership team in managing required agent goals Remote environment ensuring great performance job free of no distractions and interruptions Planned organized and coordinated work efficiently to meet assigned deadlines Detailed oriented able to handle multiple task and willing to assume new projects Assisted to achieve solutions center account key performance metrics of 95% and less than 5% abandoned calls Completed and followed up on / resolving authorization issues Verified insurance eligibility with payers, procedures and D/10 authorizations and appeals Filed and processed insurance claims electronically including HMO/PPO Medicare and state Effectively responded to routine issues regarding Medicare, Cobra and commercial insurance matters, which may involve outbound calls and other communications to resolve service inquiries Handled invoice billing complaints and discrepancies, issuing credit memos when necessary Enrolled employees in COBRA and handle associated paperwork Monthly invoices for clients for COBRA Maintained accounts for clients currently utilizing COBRA Prepared insurance claims, forms documents, review them for completeness in database systems and knowledge of EOBs Contacted insured or other involved persons to obtain missing information Discussed account status or activity with patrons or customerGo Health/ Benefits Advisor tempCharlotte NC9/2016 to 11/2016Updated customer file in CRM with summary of interactionsEffectively, and empathetically communicated assisted members through important decision-making process of selecting a health Plan that matches their needs Guided inbound consumers consumer calls through the initial buying process by effectively screening them to transfer to the appropriate sales team Complied with Federal CMS and State legal requirements and standards and quickly understood Go Health policies and procedures Navigated multiple systems while assisting customers Followed up on book of business on a consistent basis by making outbound calls to prospectsAmerisource Bergen A-Line Staffing Temp Assignment Reimbursement Coordinator/Charlotte NC7/2015 to 5/2016 Worked on various pharmaceutical programs, Repatha, Entresto, and Humira Determination for support programs (Copay. PAP, Medicaid Etc) for billing, denials and claims followed up on reimbursements for payers Processed incoming enrollment forms for program support payer research, health care policy library and state management Ability to navigate through multiple computer applications while taking high volume calls Intakes and reported adverse events as directed Communicated via telephone, email, electronic messaging, fax, or written letter with employees/members, providers of service, clients and/or other insurance carriers to ensure proper claim processing and issue resolution.Renaissance Home Care/Adult Day CareIntake Coordinator Brooklyn NY 10/2014 to 12/2014Received/responded to incoming calls from referral sources or potential patients, exchanged information to identify patient needs, and determine the Companys ability to meet them. Recorded the outcome of calls either manually or in an automated manner, made follow-up calls as necessary, and identified alternative community service resources when solutions were not available. Performed initial telephone screening to determine patients appropriateness for home care services with referral sources. Advised branch staff of patient acceptance and provided all relevant information to ensure patients smooth transition to home care. Contacted referral sources to advise of referral status and provide to the clinical team who will deliver the services requested. Established potential payer sources, verified benefits with payer sources (as required by department organizational structure), negotiated rates and obtain initial authorizations and frequency of visits from case managers. Confirmed primary payers and documented conversations with payer sources.United Health Group NYC/ Field Team Leader 7/2011 To 12/2012Supervised team members and team procedures and processes Ensured there were always a few team members at the marketing sites Delegated duties, worked with other teams to ensure clients needs were met through out sales process Conducted facility one on one training strategies Ability to inspire through trust, and lead by example Marketed Medicaid products to all interested eligible candidates. Ability to build community relationships, driving self-generated sales and meetings Coordinated and conducted approved marketing events generated referrals utilizing community resources, Met sales goals and metrics for my teams division Reached out to prospected leads and converted leads into appointments Provided ongoing assistance to Medicaid members, as necessary, educated and answered questions and/or directed inquiries to Customer Service.Amerigroup Community Care NYC 11/2010 to 7/2011 Long Term Care CoordinatorAccepted referrals from the Amerigroup Health Plan, Made initial contact with hard-to-reach members and promoted coordination in the delivery and receipt of services to enrollees assigned by Accountable Care Organizations (ACO) and NYC Managed Care Organizations (MCO) Scheduled Intake appointments for Care Coordinators as appropriate. Informed potential member of Participation Agreement and facilitated sending it to the enrollee. Completed Social Needs Assessment as required. Fostered and maintained collaborative relationships with PCPs, Social Service Providers and representatives from state agencies. Facilitated enrollee's access to needed services, including but not limited to, Flexible Services, ACO/MCO chronic disease management programs, Long term care specialists and other Community Resources.Metro Plus Health Plan Health and Hospital Corp NYC 10/2001 to 10/2009 Human Service Specialist IIMaintained assigned 130 caseloads monthly, which consisted of processing applications for the following programs NYC Food and Nutrition Services, (FNS), NYC Medicaid and Work First Program Interviewed and assisted customers or clients with processing food stamp applications and re-certification for non-assistance food stamp benefits by collecting and verifying information to determine initial and continued eligibility assistance. Processed changes reported by customers or clients through periodic or monthly phone contact, mailed re-certification, change report form, computer generated messages, etc; may conduct home visits to individuals unable to come to the office. Collected, analyzed, and verified all necessary information to determine benefits, computed mathematical data for benefit eligibility/allotment. Assessed client and household needs and made referrals to appropriate local and state resources and explain eligibility requirements and services offered by external service agencies in order to assist the customer in making an informed decision.EducationBOROUGH OF MANHATTAN COMMUNITY COLLEGEASSOCIATES DEGREE HUMAN SERVICES 1/2013 to 6/2014SkillsCustomer serviceBuild relationshipsCommunication.Generate new business /Problem-solvingAttention to detailAnalytical skillsKnowledge of Next Gen Arms,ERL Outlook Maces, Portico, Omni, Microsoft Word, Excel File Net, ABS, Rx Claims CRM, SharePoint knowledge, various network applications for claims and billing. Understand how to interpret Explanation of benefits, SOB and claims. Accounts receivable follow ups, obtaining authorizations and denied claims. |
