Results-driven US Healthcare Insurance professional with expertise in Individual Medicare Advantage plans. Expert in Medical Terminologies, Clinical Procedures and the end-to-end claims lifecycle. Proficient in navigating Medical Authorizations, Appeals (Expedited Pre-Service & Standard Pre- & Post-Service), and Grievance resolution. Knowledgeable in interpreting CPT, HCPCs and ICD-10 diagnosis codes to explain complex medical denials and benefits to members. Recognized for leadership success as a Product Trainer and Team Lead, consistently delivering exceptional customer service, driving high member satisfaction, and achieving operational excellence.
