Elysha Cautela
A high-energy, detail oriented professional with six years of experience in Appeals, Customer Service and Design.
- Role
- Appeals Specialist at Independence Blue Cross
- Location
- Worcester County, MA, US
- LinkedIn followers
- 500 followers
Experience
Appeals Specialist
Jan 2018 — Present · Philadelphia, PA, US
As an Appeals Specialist, I research and investigate appeals initiated by our members. This includes:• Reviewing claims, prior authorizations, inquiries and other pertinent information that is required prior to the appeal determination;• Reaching out to members and providers to gather necessary information for the appeal process;• Serving as primary point of contact for all external and internal stakeholders involved in the appeal and needed for the decision-making process; • Investigating rules and guidelines with internal contacts when required for the appeal;• Personally liable for maintaining compliance for 30 to 40 cases at all times;• Documenting the entire appeals process in detail for records;• Remaining well versed on regulatory requirements and guidelines for the appeal process; • Providing appeal decision via letter to necessary stakeholders within compliance timeframes; and• Responsible for the effectuation of overturned appeals
Education
Delaware College of Art and Design
Associate of Arts (A.A.)
2010 — 2012
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