Iliana Carrillo

• Effectively identifies root cause of complex issues acting as a member advocate in various cases.
• Assists in the development of process improvement functions.
• Assures timeliness and appropriateness of appeals according to state and federal guidelines.
• Requests and obtains medical records, notes, and/or detailed bills as appropriate to assist with research.
• Determines appropriate language for letters and prepares responses to appeals and grievances while generating denial letters.
• Enters denials and requests information into systems and prepares documentation for further review.
• Addresses and resolves a wide variety of basic to complex member, provider and other issues.
• Assists with interdepartmental issues to help coordinate problem solving in an efficient and timely manner.
• Creates and maintains statistics and reporting for various teams and departments.
• Works with provider & member services to resolve balance bill issues and other member/provider complaints.
• Demonstrated ability to manage multiple projects and remain flexible.

• Effectively identifies root cause of complex issues acting as a member advocate in various cases.
• Assists in the development of process improvement functions.
• Assures timeliness and appropriateness of appeals according to state and federal guidelines.
• Requests and obtains medical records, notes, and/or detailed bills as appropriate to assist with research.
• Determines appropriate language for letters and prepares responses to appeals and grievances while generating denial letters.
• Enters denials and requests information into systems and prepares documentation for further review.
• Addresses and resolves a wide variety of basic to complex member, provider and other issues.
• Assists with interdepartmental issues to help coordinate problem solving in an efficient and timely manner.
• Creates and maintains statistics and reporting for various teams and departments.
• Works with provider & member services to resolve balance bill issues and other member/provider complaints.
• Demonstrated ability to manage multiple projects and remain flexible.

high school education