Molly K. McCaughey

• Provided exceptional service through prompt responses and clear policy explanations during claims processing.
• Demonstrated attention to detail in reviewing medical records, enabling precise assessments of functional limitations.
• Maintained strong knowledge of medical terminology to understand services and procedures better.
• Worked closely with vocational rehabilitation specialists to create customized retraining programs for clients.
• Engaged in effective negotiations for disputed claims, balancing company interests with client satisfaction levels.
• Conducted internal quality audits, contributing insights that led to improved claim processing procedures.
• Increased client retention rates by nurturing relationships through consistent updates on claim statuses.
• Identified potential fraudulent claims through meticulous investigations aligned with disability guidelines.

• Achieved timely completion of various tasks while maintaining high standards.
• Ensured a professional and safe environment for all employees and patrons.
• Enhanced customer satisfaction by promptly addressing disputes and ensuring service excellence.

Set up, coding, and maintenance of claims payment system.

Proposal, contract, and legislative compliance analysis for claim processing enhancements.

Liaison to sales, contracts, eligibility, programming, underwriting, management, and customer service departments.

Company/division representative at systems, benefits, health fair events.

• Conducted regular audits to ensure adherence to established protocols, maintaining consistency across the organization.
• Trained team members on quality assurance principles, fostering a culture of accountability and high performance.
• Facilitated communication between departments regarding quality concerns, fostering collaboration towards shared goals.
• Enhanced product quality by implementing comprehensive QA processes and procedures.
• Improved customer satisfaction ratings through meticulous attention to detail and consistent quality control measures.
• Monitored staff organization and suggested improvements to daily functionality.
• Recorded, analyzed, and distributed statistical information.