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106

case manager

  • Responsible for rebuilding the customer relationship with Direct TV due to repeat technical issues and providing them a long term solution.
  • Researched billing inquiries, equipment upgrades and programming changes to meet the customer’s wants interests and needs.
  • Responsible for for taking escalated calls on a day  to day basic
  • Supported agents on providing feedback on case closures to ensure the case is being closed properly and with correct resolution. 
107

case manager, centralized appeals unit

  • Documented and analyzed the accounts recorded in multiple software applications  
  • Coordinated with Senior Appeals Specialist and corporate attorneys to develop and present cases to administrative law judge, insurance committees, and executive council regarding adverse benefit determinations and Recover Audit Contractors (RAC) reviews  
  • Trained in McKesson’s INTERQUAL criteria  
  • Classified Expert Documentation Witness  
  • Certified Legal Nurse Consultant