Phaon Clewis

Mesquite, Texas ***** 214-***-**** adjhpb@r.postjobfree.com www.linkedin.com/in/phaon-clewis-5847511a8/ CUSTOMER SERVICE, ADMINISTRATIVE LEADERSHIP, INSURANCE MULTICHANNEL COMMUNICATIONS CUSTOMER NEEDS ANALYSIS RELATIONSHIP MANAGEMENT Diligent administrative and claim professional with a history of supporting leaders and team members in fast-paced corporate environments. Recognized as a trusted partner known for building strategic alliances to mitigate organizational risks while ensuring speedy responses to business concerns. Reputable for developing, implementing, and communicating policies and objectives, handling unforeseen issues and serving as a liaison to clients, internal staff, and external contacts. Key Skills & Knowledge

•Claims research & Investigation •Claim processing and adjudication •Eligibility Determinations •Project Management •Excellent communication and organizational skills •Ability to interpret and disseminate company policies and procedures •Customer Service and Problem Resolution •Onboarding, Training & Mentoring •Team Development •Strong attention to detail and organizational skills •Ability to work independently as well as part of a team •Remote Work, Multi-tasking and Call Center Experience. PROFESSIONAL EXPERIENCE

WebTPA Irving, Texas

Member Experience Specialist November 2020 – Current

Medical claims investigations; processing and adjudication as necessary.

Review and process insurance to verify medical necessities and coverage under policy guidelines.

Engage with members to identify their needs and provide solutions to enhance their health outcomes.

Customer service, handling inbound customer calls from both providers and members.

Making outbound calls to members to assist in their health outcomes.

Providing exceptional service at all times and maintain a high accuracy level by providing complete and accurate information at all times.

AmTrust North America Dallas, Texas April 2011- June 2020 Legal Bill Reviewer (February 2016-June 2020)

Reviewed invoices submitted by law firms to ensure compliance with timely processing and analysis against billing guidelines and service level agreements. Played an integral role in litigation spend management through the analysis of law firm invoices. Maintained daily workflow through the auditing of legal bills on multi-jurisdictional claims. Resolved issues and provided timely responses to issues with strict adherence to policies and guidelines.

Routinely surpassed monthly productivity goals.

Garnered recognition for cost savings of over $300,000 annually through the re-deducting of legal expenses and fees.

Annual cost-savings of 20% by conducting an analysis of 10 million dollars of legal billings.

Positively impacted the bottom line by thoroughly reviewing and adjusting an average of 667 firm contested appeal invoices per quarter.

Served as department trainer. Onboarding and provided on-the-job training to new hires and existing staff.

Provided support to team members, supervisors and outside customers who interfaced with our platform.

Created documents and forms to seamlessly transition new hires into the organization as well as serving as refresher training for established auditors.

Fast Track Supervisor (March 2014- February 2016)

Transitioned to a project based leadership role responsible for managing a team of 6 Fast Track Auditors to execute a large volume of quick turnaround resulting in a decreased backlog and timeliness of processing.

Implemented process improvement, including a fast track bill review efficiency resulting in a 30% increase of timely payments.

Streamlined departmental training efforts.

Created documents and forms aimed at transitioning new hires into the organization.

Provided refresher training for established auditors.

Interviewed potential candidates and contributed to hiring decisions. Legal Bill Analyst (April 2011-February 2014)

Recruited to complete the timely verification of required information and audit of legal bills submitted by panel counsel for accuracy and guideline compliance.

Ensured timely payment of invoices through analyzing and adjusting legal reserves on the invoice.

Communication with law firms, claims adjusters and supervisors to submit accurate information for the review, processing, and payment of invoices to reduce and eliminate redundant billing. Cambridge Integrated Carrollton, Texas April 2009- May 2011 Administrative Services Co-Supervisor

Accountable for a team of 11 Clerical Claim Assistants.

Ensuring quality work through effective training and development.

Provided efficient training of team members to accurately complete jurisdictional forms and documents.

Established department objectives, production goals, and quality standards through collaboration with co-manager.

Manage calls and correspondence including mail and packages received.

Track and manage office supplies.

EDUCATION

North Central College Naperville, Illinois Bachelor of Arts Notary Public STATE OF TEXAS

Licensed Workers’ Compensation Adjuster TEXAS DEPARTMENT OF INSURANCE

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