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resolution specialist

  • Visually Inspect each page of medical records for completeness and legibility
  • Handle a high volume of continuous records
  • Ensure proper documentation is included in each record as directed by client
  • Remove pages from records that are not required or non-medical
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resolution specialist

  • Advises clients of benefits and eligibility analysis of their policy plan
  • Medical claims issue handling in addition to reviewing and adjusting
  • Creation of prior authorization for inpatient and outpatient procedures 
  • Provided vendors with guidance in handling difficult or complex problems or in resolving escalated complaints or disputes.
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resolution specialist

  • Managing and assisting the team of 10-15 peoples to achieve their target.
  • Providing process advise to customer service agents.
  • I have also worked as Training Specialist (3 months) where I’ve given process and comm training to new associates
  • I have worked as Quality Analyst (2 months) and tracked quality and utilization methods by monitoring the error and process gaps closely.
  • Providing formal and informal feedback to the agents to improve productivity and performance.
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resolution specialist

  • Review records or reports pertaining to activities such as monitor work activities, or evaluate performance.
  • Critically monitored customer service operations to assess agent performance and provide evaluations and feedback.
  • Effectively communicated with different departments through use of strong listening, open-ended questioning and appropriate response skills.
  • Coached team members to deliver hospitable, professional service while adhering to set service models. 
  • Helped employees with day-to-day work and complex problems by applying motivational and analytical strategies.
  • Supervised and guided new employees and responded quickly to questions, which improved understanding of job responsibilities.
  • Supported senior management in executive decision-making by drafting informative reports.
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senior resolution specialist

  • Act as supervisor on escalated calls 
  • Assist agents with resolving  customer complaints or answer customers’ questions regarding policies and procedures.
  • Take all incoming calls in a high call volume call center
  • Experience in AS400(Rxclaims)
  • Very knowledgeable of HIPAA (Health Insurance Portability and Accountability Act   and Medicare Part D 
  • Navigate multiple system 
  • Notate every inbound call with detailed notes