elizaglow

Reviewed Medicare appeals, grievances, and executive complaints, ensuring compliance with HIPAA/CMS standards. Analyzed claim denials using Facets, UNET, and SQL, resolving errors with medical records and contract research. Conducted QA reviews, identifying trends and enhancing team accuracy via SOP feedback. Specialized in UBH processes and NJ Consent Forms, routing complex cases effectively. Leveraged Power BI and process mapping to visualize trends and train staff in Agile practices. Collaborated with Network Management and Claims Operations on provider complaints and DOI inquiries.

Resolved prescription inquiries and billing disputes with empathy, ensuring timely outcomes. Supported technical assistance line, troubleshooting system issues and guiding users through portals. Processed orders and verified eligibility using Avaya and RxHD, maintaining HIPAA compliance. Improved response efficiency by tracking inquiry trends with Microsoft Office tools.

Managed flight reservations and itinerary changes in a high-volume call center for British Airways. Resolved delays and ticketing issues, de-escalating callers with researched solutions. Processed bookings via VCC systems, ensuring accurate flight and pricing details.

Progressed from Representative to Supervisor, overseeing 10-15 agents and boosting team metrics. Handled escalated calls, resolving billing and service disputes with empathy and research. Trained new hires on call techniques, systems, and policies, enhancing productivity. Implemented QA processes, including coaching and call monitoring, to improve performance. Analyzed trends and recommended process improvements until role ended due to downsizing.