Route Correspondence Case Study

Receive written correspondence inquiries and appeals from participating/ non-participating providers and affiliate healthcare vendors. Analyze all forms of written inquiries to provide a clear concise resolution within the benefit plan and contract terms. Route correspondence cases to appropriate service departments. Interacts with various departments to obtain directives and resolution. Knowledge of multiple in-house databases and portals, plan products, claim processing, authorization requirements, medical coding and terminology. In addition to the commercial group policies, I also analyze and provide response to the ND50 e-mail correspondence inquiries successfully on all product levels providing an immediate rapid reply. As required, I