Elk Grove, California, United States
I am a fast learner in which I enjoy prioritizing my task. I use interpersonal and leadership skills to critically think when delegating. I strongly communicate with peers and colleagues to solve issues and have a compassion to help others.
Single point of contact that engages, consults, and educates members needs and preferences to help them understand Aetna plan benefits details, additional plan details, tools, and resources. Answer questions and resolves issues based on phones from members concerns based on their plan benefits, eligibility, claims, accumulators, and cost sharing. Determines medical necessity, applicable coverage provisions and verifies member plan eligibility correspondence and internal referrals. Ability to multitask with several systems, ex websites and documenting systems while providing efficient and accurate information to members. Processes claim referrals, claim handoff, complaints with member and providers, grievance and appeals and handles requests for appeals and pre-authorizations
Responsible for a variety of tasks including collecting patient information, issuing medical files, filing medical records, processing patient admissions and discharge papers. In-depth knowledge of medical terminology, processes, and administrative duties which include assisting in audits.
Monitors advertisement short form videos ensuring legal compliance and safety of monetized advertising content uploaded to the platform. Uphold high standards of accuracy and quality to improve efficiency by participating in frequent refresher trainings. Cooperate with other business-related functions to complete the designated work and handle temporary tasks.
Assisted with a top company working with Escrow officers and Real Estate companies in processing the release of earnest money in closing packages to buyers, Lenders, Mortgage Brokers, Listing Agents, Selling Agents, and Homeowners Associations correspondence. Process funding of $50k and over by overnight mail or regular mail.