Open To Work
Velvet Gantt
Lugoff
Work Preference
Summary
Dynamic professional with extensive experience in claims processing and eligibility review at Accredo Specialty Pharmacy. Proven ability to enhance operational efficiency through process improvement and effective communication. Skilled in database management and customer relationship management, ensuring compliance and accuracy in all interactions. Committed to delivering exceptional service and resolving complex issues.
Overview
25
25
years of professional experience
Work History
Eligibility Representative
Accredo Specialty Pharmacy
Memphis
09.2021 - Current
- Assessed patient eligibility for specialty pharmacy services to ensure compliance with program requirements.
- Coordinated with healthcare providers to obtain required documentation for eligibility verification.
- Documented patient interactions and eligibility determinations to support accurate case management.
- Collaborated with team members to resolve complex eligibility issues.
- Processed insurance claims through electronic systems efficiently.
- Maintained accurate records of all interactions with clients.
- Provided customer service support in a professional manner.
- Answered questions regarding program requirements, policies and procedures.
- Participated in various meetings and training sessions to enhance skills and knowledge.
Claims Specialist
Enstar Group
Columbia
12.2014 - 06.2021
- Processed claims for worker's compensation and commercial insurance, ensuring accurate and timely resolution.
- Oversaw Medicare ISO reporting data, maintaining compliance and accuracy in reporting.
- Send requested documents to attorneys, and assist the finance department with payment requests.
- Process invoices for adjusters.
- Processing Paladin Invoices from India- FCM, CEP, PCM, LZ & UR claims.
- Assisted co-workers with various tasks to enhance teamwork and productivity.
Analyst Business Tester II
Companion P&C
12.2011 - 12.2014
- Process and review data in testing for errors in system and developing matrices for WC, CPP, Auto, & Umbrella Policies.
- Research websites and analyzed data to verify if system information is correct for implementation.
- Coordinated with departments to implement changes ensuring compliance with regulations.
- Process audits for Freestone on their system.
- Work closely with multiple Program Partner/Agents to make sure policies are processed, renewed, endorsed, cancelled or reinstated correctly insuring coverage adequacy.
- Also, evaluated that the correct forms are attached for compliance and verified the commercial statistical coding and reviewed rates for accuracy.
- Updated symbols, program descriptions, and lines of business in the Policy Symbol List, Program Guide, and Salesforce site.
- Work closely with all departments to validate how Companion mailings are processed and distributed.
- Maintained Salesforce database, updated partner information and TYD financials, ensuring all contracts, agreements, and legal documents were current.
- Implemented a new database on K: drive for financials, claims, reinsurance, policy data reports received and created a spreadsheet showing naming conventions and folders where reports are stored.
- Process the distribution of dividend checks after making sure calculations, policy, forms etc. are correct.
- Trained others to handle the Bordereau process and how to save all fee reasonableness verification to the K: drive.
- Maintained accurate records of WCIRB policies for BNA to support compliance and information distribution.
- Provided the Centerpost notifications to Agents through Once & Done.
Assigned Risk Underwriter
Companion P&C
04.2006 - 12.2011
- Reviewed applications, quotes, renewals for Dallas National's implementation to ensure comprehensive coverage adequacy.
- Reviewed applications, quotes, renewals for Dovetail's implementation to ensure comprehensive coverage adequacy.
- Worked with agents and insureds via phone or correspondence.
- Managed cancellation and reinstatement processes for South Carolina non-owned insurance policies to maintain compliance and service continuity.
- Ensured compliance in audit processing procedures.
- Trained new hires and department personnel.
- Assisted in creating training manual for Assigned Risk Department.
- Provided assistance in bids for contracts.
Assigned Risk Customer Service
Companion P&C
04.2003 - 04.2006
- Processed applications, endorsements, renewals, and quotes from underwriters to ensure timely policy administration.
- Worked with agents and insureds via phone or correspondence.
- Processed rate changes.
- Processed SC Non-Owned cancellations and reinstatements.
- Executed special projects to enhance operational efficiency.
- Developed workflow program to streamline processes and enhance operational efficiency.
- Performed training of new hires and department personnel.
- Tested for All Assigned Risk states-reported system errors.
- Created bids for Workers Compensation contracts to support competitive positioning in the market.
Claims Processor
Tri-care For Life
08.2001 - 04.2003
- Reviewed and processed medical claims for accuracy and compliance.
- Collaborated with insureds and physician offices to clarify and resolve claim inquiries.
- Conducted orientation and training for new employees and team members.
Education
B.S. - Music
Holmes Bible College
Greenville, SC01-1987
High School Diploma -
Lugoff-Elgin
Lugoff, SC01-1982
Diploma - Insurance
The Institute Website
01-1982
Skills
- Patient eligibility review
- Power Customer support
- Eligibility procedures
- Database management
- Healthcare software
- Claims processing
- Process improvement
- Workflow optimization
- Eligibility review
- Word
- Document management
- Quick base
- AS 400
- Vision
- Communication effectiveness
- Once & Done
- Documentation and reporting
- Healthcare eligibility
- Customer relationship management
- Effective communication
- Verbal communication
- Document management
- Phone etiquette
- Confidentiality
- Communication skills
- Data analysis
- Reporting documentation
- Proficiency in [software]
- Problem-solving
Affiliations
- Singing, Photography, CD Compilations, Calligraphy,
Timeline
Eligibility Representative
Accredo Specialty Pharmacy
09.2021 - Current
Claims Specialist
Enstar Group
12.2014 - 06.2021
Analyst Business Tester II
Companion P&C
12.2011 - 12.2014
Assigned Risk Underwriter
Companion P&C
04.2006 - 12.2011
Assigned Risk Customer Service
Companion P&C
04.2003 - 04.2006
Claims Processor
Tri-care For Life
08.2001 - 04.2003
B.S. - Music
Holmes Bible College
High School Diploma -
Lugoff-Elgin
Diploma - Insurance
The Institute Website