Resourceful professional with eight years of experience in healthcare, specializing in benefit administration and member advocacy. Demonstrated expertise in claims processing, policy interpretation, and dispute resolution. In-depth knowledge of compliance regulations and conflict resolution strategies. Effective communicator with a proven ability to convey information to diverse audiences.

Skills

Customer service excellence

Grievance resolution

Client relationship management

Healthcare knowledge

Time management

Complaint handling

Effective communication

Attention to detail

Team collaboration

Claims analysis

Experience

Medicare Grievance Coordinator (contract)

Cigna Healthcare

Evaluated member grievances to determine investigation scope and resolution path. Prepared comprehensive resolution letters, addressing all case aspects with clarity and compliance. Grievance and Appeals Coordinator I (contract)

Centene Corporation

Conducted analysis of complex cases, ensuring resolutions aligned with applicable laws and policies. Assessed validity of claims through investigation of appeals and formulated strategic action plans. Documented and compiled essential information for thorough appeal case management. Member Care Specialist

CareCounsel, LLC

Facilitated inquiries on health plans, medical claims, coverage, and billing for Stanford Healthcare Medical Group members.

Resolved customer conflicts through strategic resource access and composed communication. Guided members in pre-authorization processes to ensure compliance and understanding. Health Concierge

Bswift

Managed HR support and benefits administration for multi-channel contact center operations. Educated customers on employer benefit plans, facilitating efficient enrollment and modifications. Resolved complex issues by handling escalated calls as team lead assistant. Guest Service Representative

Zephyr Partner Solutions LLC

Managed incoming guest calls for reservations and inquiries to enhance service efficiency. Operated PBX system for accurate placement of room service orders. Education

Associate in Arts (A.A.): Natural Science

College of Alameda

Fresno, US 93720 559-***-**** *********@*****.*** INTERVIEW AVAILABILITY LINKEDIN RESUME RECEIVED

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