Daries Francis

Experience

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  Aetna, a CVS Health Company

  Aug 2000 - Aug 2002

  Customer Service Specialist

  Processing, communicating, documenting and tracking of requests for prior authorizationsReview data for accuracy and input data into the system.Validating the member, prescribing physician, determine validity of request, work manual requests, and set urgency behind each request.Outreach to physician offices to obtain additional informationAnalyzed complex coverage issues and prepared coverage letters. Used best claims practices, investigated, evaluated, reserved, and settled claims within scope of authority, workload guidelines, time and service standards. Responsible for claims in multiple jurisdictions. Responsible for all lines of the claims process. Required understanding of different jurisdictional laws/issues. Effectively negotiated settlements of varying severity claim types. Demonstrated effective customer service skills. Provided day to day mentoring/technical guidance, education and training to other claim handlers on an as needed basis. Show less

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  Southwest Expeditors

  Jan 2003 - Oct 2014

  Transportation and Construction Business Owner

  Work with Shippers, Carriers, and Dispatchers to manager schedules.Dispatching third-party drivers and manage multiple deliveries at any given time.Process spot requests and develops new sales strategies to improve business.Resolve freight discrepancies in a timely manner.Respond to customer concerns and queries professionally.Negotiate contract and pricing agreements with carriers.Accounts payable and receivable, invoicing and payrollTravel planning, Calendar and Scheduling Show less

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  Medicine AI

  Aug 2011 - May 2012

  Client Service Representative

  • Conducts administrative intake and scripted clinical intake of calls for clinical review• Provides quality customer service through interaction with providers, administrative staff and others• Maintains customer satisfaction with products and services; provides excellent service to internal and external customers• Collects and enters confidential information ensuring the highest level of confidentiality in all areas• Maintains high-quality documentation standards when collecting and performing data entry functions• Provides ongoing telephonic support to providers and office staff• Provides administrative support to the Clinical Review Department if needed• Adheres to all HIPAA, state and federal regulations pertaining to the clinical programs Show less

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  UnitedHealth Group

  Sept 2014 - Nov 2017

  Remote Clinical Administration Coordinator

  Work at Home/Remote PositionDocuments all patient interactions in a concise manner that is compliant with documentation requirements established in Job AidsConducts in - bound and out-boundcalls for program requirements including, but not limited to: patient appointment scheduling, provider outreach, assess for special needs, Texas HealthSteps and access to care for farm worker childrenSchedules and coordinates patient transportation, and follow - up for physician appointments as neededProvides clerical and administrative support to clinical staff and managers for special projects and reportsProvides excellent customer service by serving as a resource to all internal and external customersMaintains knowledge of all health plan benefits, network, regulations, HHSC requirementsInforms members of available community resources available to help meet their needs, including but not limited to: TANF, SNAP, CSHCN, WICComplete appropriate assessments and care plans as needed to streamline patient access to careSubmits internal and external referralsAssists all patients with barriers to care Show less

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  Vanguard Emergency Management

  Oct 2017 - Nov 2021

  FEMA Individual Assistance Specialist

  Verify ownership and occupancy of damaged homesRecord damages of the interior and exterior of damaged dwellingSelect viewed damages from a list of disaster related losses; and photograph damaged property

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  SBP

  Feb 2018 - Aug 2018

  Construction Coordinator

  Developing scopes of work, including related code and standard requirementsValidating applicant-provided scopes of work, including related code and standard requirementsDeveloping and reviewing cost estimatesResponsible for purchasing appliances and delivery/set upInspecting construction repairs after completionSubmit contractor invoices to accounting department for timely reconciliation

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  Endeavors

  Jun 2018 - Apr 2019

  Disaster Case Manager

  Responsible for a variety of tasks including but not limited to disaster relief: assessments, supportive services, information and referral, financial assistance, advocacy and the development of long-term disaster recovery plans.Responsible for maintaining case files in accordance with agency policies and gathering and reporting program statistical and outcome data.Collaborate with other social service agencies to coordinate client services. Maintain accurate records of participation with eternal partners. Show less

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  Pilot Catastrophe Services

  Jan 2019 - now

  • Investigate complex complaints received via fax, phone, e-mail or mail including potential litigation concerns, concerns/complaints from the DOI and all re-opened or unresolved concerns• Update administrative systems and all required systems with accurate, complete documentation to ensure all processing is complete• Write letters and formulate responses to customer concerns• Create business object reports to identify trends and to improve processes or procedures• Provide support and guidance for claims adjusters, processing areas, process flows, work condition and documentation updates• Coordination of team workflow, team meetings, training, and document updates including team related updates• Responsible for coordinating workflow among analystsFRONTLINE, ALLSTATECAT claims wind, hail, water, lightning, fire Show less

  • Administrative Manager

    Sept 2022 - now

  • Independent Claims Adjuster

    Jan 2019 - Sept 2022
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  Ardurra

  Apr 2019 - Dec 2019

  Intake Specialist

  Interviews applicants to obtain initial information to successfully complete an application for Harris County CDBG-DR housing program to determine eligibility.Assists in determining eligibility for housing assistanceAdvises applicants/neighbors of Harris County’s housing assistance program regulations, policies, and proceduresSchedules and conducts meetings with homeowners and landlords to obtain information to process initial application. Advises and explains housing policies, rules, and forms to homeowners and landlords. Collects and verifies information. Develops and maintains professional relationships with coworkers, homeowners, landlords, tenants and other external groups to provide effective and timely customer service, information, and problem resolution. Sends receives, analyzes, and processes electronic and hard copy correspondence, documents and forms.Conducts community outreach to raise awareness of the housing assistance program and requirementsResponds to telephone, fax, email, and walk-in inquiries about program requirements and status program application and payments.Home visits performed for ADA clients who were not physically able to come into the office. Show less

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  U.S. Small Business Administration

  Apr 2020 - now

  • Implement flexible customer service initiatives for responding to customer and general public questions and concerns regarding all aspects of the disaster loan program including loan processing, legal requirements for disaster loans, loss verification, and field operations.• Supervises a team of agents approx: 30-40• Oversees and manages the day to day phone and email operations, which includes special projects, call distribution/reporting, workforce management, call monitoring, forecasting, budgeting, customer satisfaction survey, training, and quality assurance.• Develops effective call handling strategies for the CSC's automated call distribution system. Show less

  • Construction Analyst

    Jan 2022 - now

  • Lead Disaster Recovery Specialist

    Apr 2020 - Dec 2022
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  Tetra Tech

  Aug 2021 - Dec 2022

  Insurance Recovery Supervisor

  • Manage, track, and evaluate the performance of agents under my supervision• Assign claims in SharePoint to agents and ensure that the project’s clients are updated regularly. Each claim tracked to completion. • Insurance recovery for auto, home and public entity claims related to FEMA Public Assistance (PA) California - 2018 CA Campfire • Reported progress of activities to the FEMA (PA) PDMG and SI TFL• Train agents on new initiatives and processes based on FEMA guidelines and client needs• Report to Project Manager any issues and help create resolutions• Working knowledge of grant programs in order to interact with applicants, federal agency reps, peers and project manager• Support the review of insurance policies, statements of loss, scope of work and cost estimates to guide homeowners thru subrogation process to eliminate duplication of benefits Show less