Amanda A.

About Amanda A.

Healthcare Operations Specialist experienced in optimizing care coordination work flows, resolving claims and guiding members to cost efficiency in network solutions. Strong analytical and process driven approach supported by prior work in fraud analysis. Currently developing business analytics and product focused skills to drive data -informed improvements in healthcare systems.

Experience

1. Customer Sucess & Soloutions Specialist

   Zelis

   Jul 2024 — Present · US

   Provides exceptional and professional assistance in a timely, energetic and polite manner to consumers planning to have an elective surgical or medical procedure.Utilizes internal databases to run reports on consumer claim history, procedure code matching, accounts on hold, incentive check fulfillment status, claim load schedule, shopping confirmation codes, exception payments, and consumer shopping search history.Calling members\' site of service as needed to confirm status of insurance claims.Collaborates with the respective departments within I&E to identify inquiry trends and to help assist with defining the issue and developing a corrective action plan.Monitors, documents, and maintains the accurate status for all related inquiry cases, including the assigning of cases to the correct person or team for proper handling and resolution.Assist Leadership team preparing monthly reports on department\'s performance.Collaborates with the respective departments within I&E to identify inquiry trends and to help assist with defining the issue and developing a corrective action plan. Present at onsite open enrollment events.Ensured data accuracy and validated claim information.Improved scheduling workflow for members.Reduced costs by guiding members to in network facilities.Investigated trends in member procedures and escalations.Communicated with cross-functional teams

Education

• Polk State College

  Bachelor of Business Administration - BSC