Experience

Elevance Health

• United States
• Hospitals and Health Care
• 700 & Above Employee

• CXO Executive Concierge Resolution Manager

  • Jun 2022 - Present



Humana

• United States
• Insurance
• 700 & Above Employee

• Professional I Executive Resolution Team

  • Aug 2019 - May 2022

  Manage a team of Analysts and provide support to Executive and Senior Leadership Team for escalated research and investigation of member and practitioner issues.

• Medicare Claims Adjuster

  • Feb 2016 - Aug 2019

• Claims Representative

  • Sep 2014 - Feb 2016

• Clinical Pharmacy Specialist

  • Nov 2013 - Nov 2014

  • Proficient in all computer programs and systems relevant to medical claims (i.e. Argus, CCP2, CGX, CRM)• Exceptional customer service skills even in escalated situations and maintaining contact with medical facilities to determine claim accuracy• In-depth knowledge of medical terminology useful in reading medical reports, orders, prescriptions, and determining coverage• Managed and maintained escalated queues involving provider issues and Hospice notifications• Received and reviewed prior authorizations and approved according to medical records• Developed system and protocol for Hospice generated information and claim information Show less