At CVS Health / Aetna, I review eligibility, plan provisions, claim history, and supporting documents to investigate complex member concerns and determine next steps.
I explain coverage and claims resolution steps, coordinate with provider offices and internal teams, and submit eligible claims for reprocessing. I also track follow-ups and maintain HIPAA-compliant case records.
At UnitedHealthcare, I assisted members and provider offices with dental eligibility, benefits, claim status, denials, and underpayments. I investigated claim histories and documentation, then followed complex inquiries and escalations through resolution.
At Portfolio Recovery Associates (PRA), I audited interactions and processes for accuracy and compliance, and partnered with operations on coaching and process improvements. I also supervised and coached representatives and coordinated staffing and schedules.
