Au-Trina Myles

• Answering incoming calls from members, providers, brokers.
• Assist members and providers in answering all benefits questions.
• Send out all correspondences about the plan, all updated and new insurance updates
• Issue ID cards
• Review claim status and give information on how the claims were paid and processed to providers
• Assist members with finding in-network providers
• Verify monthly active employees
• Dedicated team White Glove Services
• Call providers to assist members when they cannot find member profile
• Reach out to the providers about eligibility for vision copayments, frame allowances, and lens benefits
• Email provider listing to member
• Send out an Explanation of Benefits
• Email Certificate of Coverage or Termination of Coverage letters
• First call resolution with exceptional customer service
• Processed membership applications efficiently, maintaining accuracy in data entry and record-keeping.

• Responsible for 100% of phone calls
• Assist members and providers in answering all benefits questions.
• Send out all correspondences about the plan, all updated and new insurance updates
• Issue ID cards
• Enter in New Enrollee’s
• Termed Enrollments
• Send out a Certificate of Coverage
• Sort Mail
• Enter Mail
• Enter claims into Script care
• Setup Appeals
• Review claim status and give information on how the claims were paid and processed to providers
• Assist members with finding in-network providers
• Verify monthly active employees
• Running weekly letters
• Research bills from members to see if we have received the claims for the outstanding bills
• Received incoming faxes for eligibility, claim status, claims, and checking information.
• Create Spreadsheets for new projects
• Update W-9s and update providers' tax identification numbers and addresses for payments

• Excellent oral and written communication skills.
• Adjusting claims to ensure the correct payment for the first resolution.
• Adjust for overpaid claims and underpaid claims.
• Promptly and appropriately work on spreadsheets with large claims quality.
• Manage high level of adjustments in department between 100-1,000 weekly
• Analytical and interpretive skills.
• Ability to work in a team environment.
• Issuing overpayments, adjusting claims for refunds.
• Ability to meet or exceed service expectations.
• Cross-train to assist in many departments.
• Assist in training new employees.
• Results in streamlining down turnaround time for adjustments
• Managed time efficiently in order to complete all tasks within deadlines.

Process and adjust claims for Medicaid Mental Health providers

• Received incoming calls for claims status on claims submitted.
• Answer questions from co-workers or coordination of benefits, process facilities claims, and day-to-day operations.
• Back up for my supervisor for meetings and reports, assisting in areas when needed.
• Research and handle escalated issues via email and calls.
• Overpayments and issue refunds
• Help with the writing of PnP’s created all new documents for new platform for policy and procedures.
• Specialize in adjustments and overpayments.
• Skilled at working independently and collaboratively in a team environment.

• Process and adjust claims for Medicaid Mental Health providers
• Received incoming calls for claims status on claims submitted.
• Answer questions from co-workers or coordination of benefits, process facilities claims, and day-to-day operations.
• Back up for my supervisor for meetings and reports, assisting in areas when needed.
• Research and handle escalated issues via email and calls.
• Overpayments and issue refunds
• Help with the writing of PnP’s created all new documents for new platform for policy and procedures.
• Specialize in adjustments and overpayments.
• Resolved customer inquiries through effective communication and problem-solving techniques.