Ternei Fugate

• Reviewed and processed claims to ensure compliance with policies and regulations.
• Evaluated documentation for accuracy, maintaining consistency in claim assessments.
• Collaborated with insurance providers to resolve discrepancies in claim submissions.
• Trained new team members on claims processing procedures and best practices.
• Following up on denied and partially paid claims
• Contacting patients to verify information
• Verified eligibility
• Frequently helped authorizations department requesting authorizations and appealing denials.

• Managed a high volume of claims effectively by prioritizing tasks and maintaining excellent organizational skills.
• Settled complex claims fairly by applying critical thinking, negotiation skills, and detailed knowledge of insurance policies.
• Reduced claim processing errors by conducting thorough investigations and accurately interpreting policy details.
• Processed and reviewed live health claims and adjustments
• Maintained over 90% efficiency and quality

Promoted from Customer Care Advocate II within 9 months

• Managed client inquiries, ensuring timely resolution and exceptional service delivery.
• Facilitated communication between clients and laboratory teams to optimize service efficiency.
• Trained new staff on customer service protocols and system navigation for improved performance.
• Streamlined appointment scheduling processes, enhancing client experience and operational flow.
• Provided critical and stat lab results to clients
• Created and managed new account set ups