Triage Analyst
Resume:
DeAndrea Holliman-Bryant
BlackJack, MO 63033
adsqhs@r.postjobfree.com
SUMMARY
Experienced Customer Service Medical Analyst known for providing top-notch service and leading service improvements across diverse industries, seeking to leverage experience and leadership skills within a growing diverse industry, PROFESSIONAL EXPERIENCE
United Healthcare Group
Appeals Triage Analyst 7/2021-Current
● Research and resolve written complaints submitted by consumers and physicians/providers
● Ensure complaint has been categorized correctly
● Obtain additional documentation required for case review
● Review case to determine if review by clinician is required
● Render decision for non-clinical complaints using sound, fact-based decision making
● Complete necessary documentation of final appeals or grievance determination using appropriate templates
● Communicate appeal or grievance information to members or providers and internal/external parties within the required timeframes
DSNP Navigator Specialist 5/2019 - 7/2021
● Responsible for taking calls and written communications from members
● Maintained knowledge and understanding of all systems and processes in order to effectively answer inquiries
● Obtained required information and give appropriate telephone resins and /or system updates
● Researched complex issues across multiple databases and worked with support resources to resolve member issues
● Asked appropriate questions and listened actively to identify specific issues while documenting required information in computer systems
● Created, proofread or edited correspondence and documents for internal and external circulation
● Interacted with sales, pharmacy, Housecalls staff to coordinate and navigation healthcare needs on behalf of existing or prospective members
● Interpreted and communicated policies and procedures to other parties based on knowledge of the organization
● Interpreted and communicated policies and procedures to other parties based on knowledge of the organization
● Intervened with care providers on behalf of member to assist with appointment scheduling or connections with internal specialists for assistance when needed
● Provided education and status on previously submitted pre-authorization or pre-determination requests
● Assisted members in navigating UnitedHealth Group websites
● Responded to member inquiries and complaints by phone or electronic communication
● Maintained acceptable levels of performance in productivity, quality and schedule adherence DeKalb Water Company Atlanta, GA
Customer Assurance Specialist 8/2017 - 02/2019
● Make Outbound calls to customers regarding disputes pertaining to billing issues, product problems, service questions and general client concerns
● Investigate, problem solve, and resolve resolutions that involve the water meters and high bills,
● Responsible for maintaining a high level of professionalism with clients and working to establish a positive rapport with every caller
● Update customer information in the customer service database during and after each call
● Work with the management team to stay updated on product knowledge and be informed of any changes in company policies
● Impact the company’s bottom line by problem solving and turning frustrated clients into repeat customers
CHARTER COMMUNICATIONS 6/2012-7/2017
Quality Assurance Specialist St. Louis, MO and Gwinnett County, GA Workforce Management Tech Coordinator/Supervisor, Gwinnett County, GA
● Determined if more individual or department training were required.
● Set up additional jobs needed to complete work orders that technicians were on.
● Coordinated irate customer installation and repairs.
● Reviewed and audited inbound calls
● Reported on monitored calls and analyzed trends in order to assist management on agent behaviors.
● Conducted Quality Assurance audits to identify trends/lack of trends and reported findings.
● Met daily quality audit goals.
● Determined new trends through call observation/reporting and proposed methods of changing trends through training or other processes.
● Attended supervisor team meetings to speak to what QA is hearing and provide feedback to call center agents.
● Conducted calibration sessions with supervisory team members and management to ensure all the required guidelines are being followed.
● Attended corporate calibration sessions to ensure the required guidelines are being followed, trained new hires on the corporate Quality Assurance guidelines and Account Security.
● Attended all required training to ensure the QA department was up-to-date on all new products, materials and services.
EDUCATION
Associate of Arts,
Mary Holmes College, West Point, MS
SKILLS
A S400, Lotus Telephone Etiquette, WordPerfect, Customer Service, Microsoft Word Spreadsheet, Microsoft Excel, Switchboard, Leading colleagues to improve efficiency and customer service, Improving customer experience, Project management, Patience and a positive attitude, Attention to detail, Clear and effective communication, Time management, Operational improvements
Contact this candidate