Virtual Assistant

* Take inbound calls from members with escalated claims issues, do real-time adjustments or rework and handled appeals related concern. * Perform outreaches to provider’s office and other involved parties for billing and claims clarifications, appeals related inquiry and coding. *Answered calls from the members/patients to advised them how the policy works. *Conduct provider outreach to help patients with appointment scheduling with their providers. *Insurance coverage and eligibility verification following HIPAA guidelines. *Assisted members with checking and looking for INN providers covered by their plan. *Helped members with their prescription inquiry for them to get their medication immediately. *Checked prior authorization status to determine if member can proceed with the service.

Assisted the agents by doing floor support. Performed call auditing to validate quality accuracy. Extracted team’s data to monitor team performance. Conducted coaching to agents to ensure better performance and individual development. Carry out team refreshers related to process topics ensuring everyone is calibrated.