Experience

Lumeris

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

• Claims Analyst

  • Feb 2020 - Present

  - Processes claims through timely and accurate entry of data- Performs side by side comparisons to determine corrected claim actions- Owns two complicated reports which involve critical decision making on adjustments, overrides of copayments, coinsurance, correct pricing and provider selection- Consistently exceeds production and quality metrics of 95% accuracy

• Customer Service Specialist

  • Sep 2018 - Feb 2020

  - Investigated and responded to general correspondence which included ownership and accountability for client-specific Customer Service email and voicemail inbox- Responded to questions and complaints and resolved issues via email and over the phone from both internal and external customers by following operational processes and procedures- Acted as a back-up for answering member and provider inbound calls during times of peak call volume

• Customer Service Representative

  • Nov 2017 - Sep 2018

  - Resolved inbound customer service inquiries which included: benefit and eligibility information, billing and payment issues, customer material requests, physician assignments, and more- Made outbound calls as needed to: members, providers, pharmacies, hospitals etc. to resolve issues- Interacted with other departments including Enrollment and Medical Management to resolve issues