Cierra Sheppard

Handled inbound member calls in a fast-paced contact center, applying strong time and call management skills to assist members with banking needs. Efficiently navigated multiple systems and programs while maintaining engaging member interaction across multiple channels.

Reviewed authorization-related claim denials to ensure claims were paying or denying appropriately, resolving at least 50 claims per day. Ensured providers were paid promptly to increase provider and member satisfaction, maintaining an authorization error rate of 1.85% or less.

Reviewed and analyzed provider requests to investigate claim payment or denial outcomes, determining appropriate resolutions using strict adherence to internal guidelines. Worked with various departments to determine root cause and appropriate resolution, remediating impacted claims.

Processed claims forms for payment, ensuring all information was supplied before eligible payments were made. Researched and analyzed claims to facilitate accurate and timely processing.

Initiated Emergent Inpatient/Newborn delivery and Observation authorizations, assisting members and providers with pharmacy inquiries using the Express Scripts system. Responded to customer questions via telephone and written correspondence regarding insurance benefits, provider contracts, and eligibility.

Completed high school education and received a diploma.