Summary
Work History
Education
Skills
Training Certificates
Timeline
Generic
Akira Thomas

Akira Thomas

Process Analyst
Austin,TX

Summary

Claims and Customer Service Specialist with over 12 years of experience in Healthcare and Behavioral Health. Forward thinking team player with expertise in quality assurance. And a hardworking employee with multitasking and time management abilities.

Work History

Process Analyst I

Centene
Austin, TX
2018 - 12.2023
  • Analyzed current business processes and identified areas of improvement to increase efficiency.
  • Developed process maps, flowcharts, and diagrams to document findings.
  • Documented existing process flows and identified gaps in the current system.
  • Perform day to day duties to support the functions of claims processing, configuration, Pricing accuracy, review contracts, system updates and communication of changes to stakeholders.
  • Audit provider setup and submit correction. And facilitate meetings with provider relations and clinical staff.
  • Assist in identifying methods to reduce the volume of pended and adjusted claims. And adjusted claims and recommend solutions to increase auto-adjudications rates.
  • Submit configuration requests and perform user acceptance testing (UAT) for provider specific negotiated contracts or pricing errors.

Claims Support /Claims Support Representative II

Centene
Austin, TX
2014 - 2018
  • Participated in weekly meetings with colleagues to discuss new developments in claims administration processes.
  • Performed administrative duties such as filing documents, preparing reports and scheduling appointments.
  • Provided timely updates on the status of open claims at regular intervals.
  • Research claim payment issues to identify root cause and trends to reduce incorrect payments.
  • Develop and maintain positive customer relations with internal and external customer, and coordinate with various functions within the company.
  • Receive and place follow up telephone calls/emails to answer internal and external customer questions that are routine in nature.
  • Work with Team Leadership to develop training and reference materials for Claims Support Representative team.
  • Assist in the onboarding and training of new Claims Support Representative Team. Support in the team Leadership with identifying trends, issues, training opportunities.
  • Work cooperatively to relay complex claims support issues to other functions within the organization and see issues through to completion.
  • Provided customer service support to policyholders and claimants regarding insurance claims inquiries.
  • Created and maintained accurate records of all incoming and outgoing correspondence related to claim activities.
  • Prepared detailed summaries of claim investigations for management review.

Customer Service Representative

Texas Medicaid and Health Partnership
Austin, TX
2011 - 2014
  • Answered customer inquiries and provided accurate information regarding products and services.

  • Provided excellent customer service to resolve customer complaints in a timely manner.
  • Assisted customers with product selection, ordering, billing, returns, exchanges and technical support.
  • Resolved complex problems by working with other departments to provide solutions that meet customer needs.
  • Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
  • Answered incoming calls and emails, providing frontline customer support or assistance with product and service transactions.
  • Answered inbound calls, chats and emails to facilitate customer service.
  • Consulted with customers to resolve service and billing issues.
  • Escalated customer concerns, issues and requirements to supervisors for immediate rectification.
  • Informed customers about billing procedures, processed payments and provided payment option setup assistance.

Administrative Assistant

Life Made Easy
Austin, TX
2009 - 2011
  • Organized and maintained filing systems for physical and electronic documents, ensuring accuracy and confidentiality of records.
  • Greeted visitors in a professional manner, responding to inquiries and directing them to appropriate personnel.
  • Composed letters, memos, reports, emails, presentations and other written correspondence as required by management staff.
  • Ensured efficient operation of office equipment such as printers, copiers and fax machines.
  • Coordinated mailings including sorting mail, preparing packages for shipping via courier service or postal service.
  • Entered data into spreadsheets using Microsoft Excel or other similar programs.
  • Updated contact lists regularly when changes occur in employee status or contact information.
  • Scheduled appointments between clients and customers and internal staff members.
  • Answered phone calls and emails to provide information, resulting in effective business correspondence.

Education

Associate of Science - Human Resource Management

Virginia College - Birmingham
Birmingham, AL
05.2009

Skills

  • Proficient in All Microsoft Products Software
  • Skills in Excel
  • Reporting Skills
  • Presentations
  • Paperwork Processing
  • Call Management

Training Certificates

  • Business of Interest and Busniess Courtesies
  • Fraud, Waste and Abuse
  • General Compliance and code of Conduct
  • Administrative Firewalls and Organizational Conflicts of Interest
  • Security Awareness Essentials

Timeline

Associate of Science - Human Resource Management

Virginia College - Birmingham

Process Analyst I

Centene
2018 - 12.2023

Claims Support /Claims Support Representative II

Centene
2014 - 2018

Customer Service Representative

Texas Medicaid and Health Partnership
2011 - 2014

Administrative Assistant

Life Made Easy
2009 - 2011

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Akira ThomasProcess Analyst