Leonna Charles

Edwardsville, PA *****

ad13ny@r.postjobfree.com

+1-570-***-****

Hardworking Customer Service Representative with over ten years of experience working with healthcare. Trained in project and time management with extensive knowledge of Medicare, Commercial, and Marketplace policies and proven multitasking abilities. Committed to maintaining professional relationships with clients to increase profitability and drive business results. Work Experience

Medical Claims Specialist

Infinity Healthcare

January 2022 to Present

• Respond to and resolve, on the first call, customer service inquires and issues by identifying the topic and type of assistance the caller needs such as benefits, eligibility and claims, and correspondence.

• Help guide and educate customers about the fundamentals and benefits of consumer-driven health care topics to select the best benefit plan options, maximize the value of their health plan benefits and choose a quality care provider.

• Contact doctor’s offices, pharmacies, and medical groups on behalf of the customer to assist with questions, schedule appointments, and close gaps in care. Make outreaches where necessary to with internal specialists for assistance.

• Assist customers in navigating myuhc.com and other UnitedHealth • Case Management Group websites and encourage and reassure them to become self-

• Assists in maintaining a clean, organized and efficient work area, including maintaining supplies necessary to perform job duties. • Microsoft Office

• Provide single point of contact for the member for highly designated Suite

• Excel or dedicated UHC national or key account insurance plans

• Word

• Own problem through to resolution on behalf of the member in real

• Access time or through comprehensive and timely follow-up with the

• Outlook member

• PowerPoint

• Educate members about the fundamentals and benefits of consumer- driven health care topics to include managing their health and well- being so they can select the best benefit plan options and maximize the value of their health plan benefits

• Advocate and intervene with care providers (doctor’s offices) on behalf of the member to assist with appointment scheduling, billing concerns, and coverage determinations

• Assist members in navigating myuhc.com and other UnitedHealth Group websites or applications utilizing remote desktop system capabilities

Customer Service Representative

Maximus

January 2018 to December 2022

• Answered incoming calls from consumers including the general public, prospective enrollees and people assisting enrollees or acting on their behalf in accordance with all performance standards, policy and procedures, and protocols including but not limited to the confidentiality and privacy policies.

• Facilitated the fulfillment of caller requests for materials via mail, email, or download.

• Tracked and documented all inquiries using the applicable systems.

• Processed new applications for health care coverage via the telephone including building tax household, household income, eligibility determinations, interpreting determinations made by the Marketplace, and enrollment into health plans.

• Attended meetings and trainings as requested and maintains up-to-date knowledge of all programs and systems.

• Liaising with engineering and project management teams to ensure that the project design is accu rate before work commences.

• Acting as the main point of communication between the main field and the office.

• Managing the work schedules and time cards for all field staff.

• Providing leadership to on-site staff, sub-contractors, and other parties.

• Investigating and resolving customer complaints.

• Reviewing project progress to ensure that deadlines are met

• Establish open lines of communication for individuals with mental or emotional issues

• Help individuals with substance abuse issues

• Implement and review treatment plans

• Collaborate with additional treatment providers and placement agencies. Medical Scheduler

Claims Processor (Remote)

July 2017 to December 2018

• Communicating with insurance agents and beneficiaries.

• Preparing claim forms and related documentation.

• Reviewing claim submissions and verifying the information.

• Recording and maintaining insurance policy and claims information in a database system.

• Determining policy coverage and calculating claim amounts.

• Processing claim payments.

• Complying with federal, state, and company regulations and policies.

• Performing other clerical tasks, as required.

• Process payment information utilizing the property and casualty claims systems, tools used by arbitration and subrogation or enterprise payment systems to enter, reconcile, and maintain auto claims related vendor and customer accounts.

• Research, monitor, review, and resolve any monetary discrepancies or aged invoices related to various claim payments, unidentified vouchers, manual payment operations.

• Clearly communicate status or information needed to process a member or vendor request and/or associated escalations.

• Provided excellent customer service in a high call volume situation and determining the best and most efficient way for patients to get their concerns and needs addressed by gathering the appropriate information.

• Performed a variety of administrative duties including but not limited to: answering phones; faxing and filing of confidential documents and email utilization.

• Obtaining, verify, and input demographic, insurance and referring physician information as required, document messages electronically, triage calls and assist callers in a manner consistent with the Ideal Patient Experience approach and philosophy.

• Helped with special projects for Patient Advocacy and Medical Records that required attention to detail and accuracy, fact finding and researching of problem areas.

• Daily data entry of medical appointments, special instructions, patient information/jurisdiction, and pre/post-operative instructions.

Education

High school diploma

Wyoming Valley West Shs - Plymouth, PA

October 2016 to June 2017

Skills

• Healthcare Benefits

• Claim Billing

• Documentation

• Email & Fax

• Process invoices

• Legal Documentation

• Payroll & Payroll Processing

• Policies

• Sales

• Proficient Typing sufficient. C O M P U T E R

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