Theroda Sindy Gaillard-Britt

Process all incoming faxes for same day services.

Search for Medicare Guidelines

Make calls to Providers to obtain necessary clinical do documents

Process or deny prior authorization requests

Support UM nurses to process prior auth requests

Participate in special projects as assigned by Supervisor

• Trained and developed new employees into high-performing team members.
• Generated daily, weekly, and monthly reports as well as spreadsheet reports when requested.
• Full assistance to the Care Manager including but not limited to; new member setup services, meetings, workshops, community training needs, and any other implemented program.
• Completion of daily task list as delegated from management.
• Send treatment plans and other necessary documents to patients.

• Answering and responding to a high volume of incoming calls, chats, and emails.
• Applies company policies and procedures to resolve a variety of issues, including complex issues
• Resolving billing issues
• Responsible for submitting complete and accurate reports to supervisor on a regular basis
• Adjudicating claims and billing processes.
• Researching required information using available resources.
• Place outgoing phone calls when business ventures warrant.
• Document all call information and enter data accurately and in a timely fashion.
• Utilize multiple company database programs for accessing member information through HIPAA compliance.
• Handle customer complaints, provide appropriate solutions and alternatives within the time limits; follow up to ensure resolution

• Responsible for managing a high volume of incoming calls.
• Assist members with solving difficult and critical issues relating to their life insurance policies.
• Handle customer complaints and serve with empathetic and efficient skills follow up to ensure resolution
• Effectively explained the best solution to solve the problem to the customer if a complaint was made.
• Build sustainable relationships of trust through open and interactive communication.

• Responsible for managing a high volume of incoming calls.
• Assist participants with retirement accounts, withdrawals, loans from their accounts.
• Handle customer complaints, provide appropriate solutions and alternatives within the time limits; follow up to ensure resolution

• Answering and responding to a high volume of incoming calls, chats, and emails.
• Applies company policies and procedures to resolve a variety of issues, including complex issues
• Resolving pharmacy issues from members, providers, and pharmacies.
• Responsible for assisting members with billing concerns, grievances and resolutions.
• Responding to routine inquiries on multiple products and medicare services.
• Researching required information using available resources.

• Answering and responding to a high volume of incoming calls, chats, and emails.
• Applies company policies and procedures to resolve a variety of issues, including complex issues
• Resolving billing issues
• Remotely Performing subrogation for Cigna Health Insurance and filing claims

• Responsible for requesting and securing members medical records and outbound customer assistance.
• Starting and maintaining prior authorizations and consents for medical records.
• Verified patient's health conditions and entering information into the computer.