Senior Appeals Representative

• Apr 2023 - Present

Realtor

• Mar 2021 - Present

Licensed Real Estate professional with Better Homes & Garden Real Estate Gaetano Marra Homes. Here to assist with all of your Real estate Needs! Licensed Real Estate professional with Better Homes & Garden Real Estate Gaetano Marra Homes. Here to assist with all of your Real estate Needs!

Clinical Admin. Coordinator (Telecommute)

• Dec 2011 - Apr 2023

•Respond to Incoming Provider and Enrollee calls •Resolve Customer Service inquiries •Provide high quality Customer Service to both Providers and Enrollees •Meet established productivity, schedule adherence, and quality standards while maintaining good attendance •Receive prior authorizations requests non – clinical assessment / intervention and provides appropriate triage •Process out of network requests for consideration of in network level of benefits •Process notification requirements for genetic testing procedures •Determine benefit coverage issues •Set up / documents / triages cases for clinical or medical director review •Verify appropriate ICD – 10 and CPT coding usage •Communicate to providers and members benefit determinations within time frames Show less

Independent Distributor

• Jul 2015 - Jul 2017

Stay at Home mom!!!

• Nov 2010 - Dec 2011

Promoted to Account Service Coordinator

• Oct 2007 - Nov 2010

Scheduled appointments, data entry, filing, correspondences, switchboard, fax, copy, and mail merges.Communicated knowledge of HealthNet/Guardian HCS, CBIA, Health Pass and the quad state proprietary benefit plans, contracts, rates, policies and procedures to the broker community, small employer groups and third party administrators.Assisted Customers, Brokers, and Employers with benefit questions and provided all pertinent information.Accepted increasing responsibility demonstrating flexibility and ability to learn quickly.Performed research and follow-up with appropriate internal departments in regards to all broker and small employer group inquiries.Utilized PC-based imaging technology and MC400 database to complete the daily workflow for enrollment review, benefits, claims, quoting and rates as well as utilizing the IMAX for all documentation.Provided information regarding participation requirements and benefit questions.Communicated knowledge of underwriting guidelines.Maintained strong relationships and support for brokers, general agents, and employer groups.Ensured timely resolutions and responses to all inquiries such as enrollment, claims, quoting and renewals rates, product design and plan education as well all service issues.Maintained current and accurate knowledge regarding Healthnet products, rates, enrollment procedures, claims processing, and administrative and billing procedures.Shauntear A. Gaston page 2 Show less

Customer Service Representative

• Aug 2005 - Oct 2007

Responsible to provide excellent customer service. Answered questions regarding member benefits.Answered member and provider inquiries daily regarding claims and eligibility. Data entry and documentation for every call.Assisted with resolution of member and provider issues daily.Sent requested correspondence to members and providers daily.

Customer Service Representative

• Sep 2003 - Aug 2004

High volume of inbound calls. Answered member question regarding membership. Data entry daily. Responded to member inquires via email. High volume of inbound calls. Answered member question regarding membership. Data entry daily. Responded to member inquires via email.

Assistant Manager/CSR 2002

• 2003 - 2004

Responsible for opening and closing of store Provided superior customer service daily Handled sales displays Handled large monetary cash transactions Data Entry daily Responsible for receiving and shipping merchandise Responsible for opening and closing of store Provided superior customer service daily Handled sales displays Handled large monetary cash transactions Data Entry daily Responsible for receiving and shipping merchandise

Customer Service Representative

• Jan 2001 - Jan 2002

Responsible to provide superior customer service daily Answered customer questions regarding their utility payments Data entry daily Assisted with resolution for customer issues Responsible to provide superior customer service daily Answered customer questions regarding their utility payments Data entry daily Assisted with resolution for customer issues