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Appeals Specialist
Appeals Specialist at Acentra Health resolving medical appeals and grievances with a 24–48 hour turnaround.
United StatesAppeals Specialist at Acentra Health
Handle 50–70 calls daily, resolving medical appeals, grievances, and program policy inquiries from members and providers by phone, email, and chat, consistently meeting a 24–48 hour turnaround standard. Research eligibility, benefits, claims, and service authorization issues, process medical payments and orders, and document all contacts in CRM and case management systems.
Grievance ResolutionClaims ResearchEligibility VerificationBenefits AdministrationService AuthorizationMedical Payment ProcessingCRMCase ManagementHIPAA complianceAudit ReadinessEscalation ManagementRemote Collaboration
Handled 50–70 inbound and outbound member calls daily while maintaining HIPAA compliance and service-level standards. Administered employer-sponsored healthcare benefits, processed medical payments and orders, and maintained detailed case notes.
Benefits AdministrationEligibility VerificationEnrollmentHIPAA complianceCall HandlingCase ManagementAppointment SchedulingDocumentation
Handled 100–150 inbound and outbound calls daily, including escalated billing, account recovery, retention, and service concerns. Reviewed account records, verified customer identity, and processed service requests, while consistently meeting quality and productivity targets.
Call HandlingEscalation ManagementAccount RecoveryBillingCustomer ServiceQuality AssuranceTeam LeadershipTrainingMentorship
Serviced USAA member bank accounts, loans, and claims in a high-volume, highly regulated financial services environment. Handled 100–150 inbound and outbound calls daily, resolving account, loan, and claims inquiries accurately on first contact.
Financial ServicesAccount ServicingLoan ServicingClaims HandlingCall HandlingFirst Contact ResolutionsPerformance Metrics
Pursuing studies in Business Administration.
Earned a high school diploma and completed customer service training.
Completed customer service training.
Profile sourced from Himalayas.