Insurance and Medical Client Services Manager with more than 15 years of progressive experience in the oversight of claims processing and employee management. Skilled in data collection and reporting as well as collaboration with cross-functional teams to achieve prompt resolution to client inquiries and issues. Recognized for the effective training, coaching and evaluation of colleagues to achieve both individual and corporate objectives. A motivated leader who mobilizes teams to improve the overall client experience, ultimately...
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Client Coordinator, Grievances & Appeals Department
Serve as primary investigator and point-of-contact for member and provider grievances and appeals for state-subsidized programs. Facilitate all case communications between members, providers, other representatives, and the appointed Grievance Committee.
• Educate members, providers and/or member representatives about the grievance/appeal process and their right to appeal to State or Federal agencies (if applicable), ensuring complete understanding and open communication.
• Provide assistance to members who are unable to effectively pursue a grievance/appeal, such as ensuring that an interpreter and/or translated written materials are available for the member if necessary.
• Recognized for continuous grievance and appeal compliance to state and federal regulations, contractual obligations, NCQA guidelines and Plan policy.
• Appointed dedicated Grievance Coordinator for Member (MRIP), Independent Review Organization (IRO), and Fair Hearing appeals, responsible for grievance/appeal packet preparation and submission to internal staff/external parties, including Independent Review Organizations, Corporate and DSHS Attorneys.
CENTURY 21 ALL-PRO, Parkville, MO 2006 – 2007
Licensed Broker Sales Consultant
Managed residential and commercial real estate transactions in Kansas and Missouri.
• Directed the activity of 8 real estate associates, confirming federal and state regulatory compliance and coaching on effective sales...
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