Khalipha Yaca

Key Responsibilities:

• Improved claim processing efficiency by streamlining workflow procedures and implementing new software tools.
• Conducted comprehensive evaluations to determine eligibility for benefits, ensuring compliance with company policies and regulations.
• Actively participated in internal quality audits, contributing valuable insights for continuous improvement of claim processing procedures.
• Supported the development of new claims management software, providing valuable input based on experience and expertise in disability claims handling.
• Demonstrated attention to detail when reviewing medical records, enabling accurate assessment of functional limitations caused by disabilities.
• Played a critical role in resolving customer complaints by addressing concerns and providing clear explanations about claim decisions, maintaining positive relationships with clients.
• Reviewed outstanding requests and redirected workloads to complete projects on time
• Coordinated with contracting department to resolve payer issues
• Communicated verification and authorization status updates with department to facilitate decision-making for patient admissions and insurance coverage.
• Carried out administrative tasks by communicating with clients, distributing mail, and scanning documents
• Maintained confidentiality of patient finances, records, and health statuses
• Notified insurance agents and accounting departments of policy cancellations and changes

• Evaluated patients, established goals and develop individualized treatment plans.
• Enhanced overall quality of life for patients with chronic conditions by addressing physical, cognitive, psychosocial, and sensory impairments.
• Established rapport with diverse populations including pediatric, geriatric, mental health clients to ensure effective communication throughout treatment process.
• Collaborated with interdisciplinary team members for comprehensive patient care and optimal results.
• Coordinated discharge planning efforts alongside case managers to ensure seamless transitions between care providers upon leaving facility.
• Improved patient outcomes by implementing individualized treatment plans and monitoring progress.
• Educated patient and family regarding patient abilities and need for assistance and continued therapeutic intervention.
• Customized standard plans to meet individual abilities and needs
• Recommended equipment to use in-home to maximize opportunities for wellness
• Performed evaluations and assessments to recommend best treatment for individual patients
• Consulted with direct-care staff to implement best methods to achieve therapy goals
• Performed assessments during treatment to determine progress according to goals

• Built strong relationships with members to promote health, wellness and available services.
• Performed screenings for markers such as blood pressure, cholesterol, HIV, weight and BMI.
• Created and submitted weekly team and agent reports.
• Provided individual health coaching to help clients optimize personal choices.
• Collaborated with health and wellness professionals to create and execute events, seminars and workshops on various topics.
• Built strong relationships with members to promote health, wellness and available services
• Performed screenings for markers such as blood pressure, weight and BMI
• Met or exceeded monthly revenue and training goals
• Enhanced team performance against goals by coaching and motivating clients
• Provided individual health coaching to help clients optimize personal choices

• Completed daily cold calling and outreach to build sales pipeline.
• Handled high-volume telemarketing operations with expert use of client management software and computer dialing.
• Explained product prices and packages as well as answered questions and addressed concerns of customers.
• Recorded contact information of customers and potential customers in internal database.
• Completed daily cold calling and outreach to build sales pipeline
• Displayed excellent sales skills and understanding of how to leverage abilities to exceed quotas
• Answered calls, took messages, and transferred calls to correct individuals
• Handled high-volume telemarketing operations with expert use of client management software and computer dialing
• Recorded contact information of customers and potential customers in internal database