Industry:Healthcare / MedicalEmployment Period:October 2006 to May 2020 (163 Months)Duties and Responsibilities:
- Responsible for defining the business processes, the business policies and the application requirements.
- Leads the business rules acquisition activities as a domain expert and uses the Rules Management Application as reviewer.
- Ability to accept and implement coaching and feedback in order to achieve individual and team performance goals.
- Provide update to provider about eligibility and benefits of the policy holder.
- Gather all statements from insured clients, physicians for all claim information and evaluate all facts for policy contracts.
- Investigate and prepare reports for all denials of claims and settlements and provide update on all files and recommend reserve changes to all claims.
- Evaluate progress for all claims and coordinate with team leader for all issues and effective resolution and develop new methods to handle all claims.
- Administer and settle all claims effectively and inform all customers and claimants for any denial on claims.
- Perform various administrative functions for assigned accounts, such as recording address changes and purging the records of deceased customers
- Resolves problems by clarifying issues; researching and exploring answers and alternative solutions; implementing solutions; escalating unresolved problems.