Answers 20-50 inbound calls daily about healthcare service requestswith a 100.%+ resolution rate, ensuring strict HIPAA compliance andaccurate documentation.
Works with members, providers, pharmacy and key departments topromote and understand medical and prescription insurance ,processes and requirements.
Delivered empathetic, patient-focused support about benefit, claims,billing and prior authorization across providers, pharmacies, and casemanagers.
Conducted, prepared and analyzed weekly and monthly quality reports(QA alerts, EOM evaluations, PKT results) to track performance andidentify improvement areas and ensuring adherence to processes andcompliance standards.
Provided one-on-one coaching and feedback, improving agentaccuracy, compliance, and communication skills.
Facilitated calibration sessions with team leads to ensure consistentand fair scoring, aligning performance standards across the team.
As a Subject Matter Expert (SME), guiding agents and resolving complexhealthcare concerns related to billing, benefits, claims, and priorauthorizations.
Designed and updated FAQs, process guides, and internal knowledgearticles, ensuring the team had the most accurate and up-to-dateresources.
Delivered onboarding, mentorship, and ongoing training to 20+ newhires, helping them build confidence and achieve performance goalsfaster.
Monitored trends in customer concerns and agent performance,flagging recurring issues early and creating coaching plans or processupdates to prevent future problems.
Verified
