Alicia West
Summary
Seasoned collaborator experienced in meeting needs, improving processes and exceeding requirements in team environments. Diligent worker with strong communication and task prioritization skills. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.
Overview
17
17
years of professional experience
Work History
Customer Service Trainer
Elevance Health
05.2022 - Current
- Provided coaching and mentoring to employees.
- Trained and mentored new personnel hired to fulfill various roles.
- Conducted needs assessments to identify gaps in performance and develop targeted learning solutions.
- Established and maintained quality control standards.
- Analyzed and evaluated training effectiveness and program outcomes.
- Coordinated training schedules across sites with supervisors and managers to optimize training initiatives and work-flow management
- Facilitated virtual learning sessions.
- Developed and implemented successful onboarding program.
Cognitive Counselor
St. Brides Correctional Center
12.2019 - 05.2022
- Worked collaboratively with other mental health professionals to provide consistent care and minimize diversion.
- Observed and monitored client behavior and responses to treatment.
- Consulted with other staff members regarding treatment plans as deemed appropriate by team leader.
- Encouraged patients to discuss experiences in group and individual settings.
- Provided comprehensive case management services, created treatment plans, and connected clients and families to appropriate resources.
- Developed goal-oriented psychoeducational and activity therapy groups to improve clients' level of functioning.
- Completed one-on-one counseling with broad range of clients suffering from substance use disorder and various mental health issues.
- Self-motivated, with a strong sense of personal responsibility.
- Skilled at working independently and collaboratively in a team environment.
- Managed time efficiently in order to complete all tasks within deadlines.
Workforce Management Analyst I
Anthem
08.2018 - 10.2019
- Set and adjusted to schedules to maintain optimal coverage and service levels.
- Managed overtime, shift swaps, breaks and PTO requests.
- Produced and updated documents, reports and tracking spreadsheets using Excel and MS Access.
- Collected and analyzed information to monitor compliance outcomes and identify and address trends of non-compliant behavior.
- Worked with management to develop strategic and tactical plans to meet different requirements.
- Created and maintained Excel database to track inventory performance.
- Created and published ad hoc reports to internal shared site.
- Performed real time analysis on claims and provider appeals inventories to identify trends and potential issues within the inventory levels.
Provider Grievance and Appeals Representative
Anthem
02.2017 - 08.2018
- Rendered decision for non-clinical complaints using sound, fact-based decision making.
- Obtained additional documentation required for case review.
- Completed documentation of final appeals or grievance determination using appropriate templates.
- Examined case to initiate clinical review.
- Researched and resolved written complaints submitted by physicians or providers.
- Processed and finalized appeals and grievances within agreed-upon turnaround time.
- Remained knowledgeable regarding company policies and procedures and current developments within operational departments.
- Submitted verbal and written notification to providers of the outcome of their appeal.
Enrollment and Billing Representative I
Anthem
09.2015 - 02.2017
- Reviewed and solved account and billing discrepancies.
- Identified, researched, and resolved billing variances to maintain system accuracy and currency.
- Received incoming information and entered into database system.
- Performed quality assurance evaluations on associates to ensure adherence of company policies and processes.
- Processed and verified invoices to secure accuracy of billing information.
- Identified payment trends and adjusted billing processes accordingly to retain customers.
Credentialing Associate
Anthem
07.2014 - 09.2015
- Conducted primary source verifications such as background checks and board certifications.
- Received and evaluated applications to look for missing and inaccurate information.
- Obtained NPI numbers for providers and facilities and updated existing profiles.
- Performed various administrative tasks by filing, copying and faxing documents.
- Served as resource for physicians in credentialing and privileging process.
Claims Representative II
Anthem
01.2009 - 07.2014
- Analyzed and addressed escalated claims to resolve issues quickly.
- Worked productively in fast-moving work environment to process large volumes of claims.
- Researched and analyzed complex claims to determine next steps and possible outcomes.
- Updated claims system to track claim status and provide relevant information to other department.
- Collaborated with internal departments and external vendors to achieve fast resolution of claims.
- Examined reports, accounts, and evidence to determine integrity and accuracy of information.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Calculated adjustments, premiums and refunds.
Enrollment Representative II
Anthem
12.2006 - 01.2009
- Maintained detailed and accurate records between multiple databases and programs.
- Conducted annual reviews of existing policies to update information.
- Educated clients on insurance policies and procedures.
- Assisted with design and implementation of various employee benefits programs.
- Proved successful working within tight deadlines and a fast-paced environment.
- Educated and engaged customers with new bank products and services.
- Responded to customer calls and emails to answer questions about products and services.
- Maintained and managed customer files and databases.
- Processed new business account set up, benefit conversions, terminations, and addition of products.
- Uploaded new group benefits and rates to internal system.
- Maintained enrollment database.
Education
Master of Science - Criminal Justice
Saint Leo University
Saint Leo, FL05.2019
Bachelor of Social Work - Social Work
Norfolk State University
Norfolk, VA12.2016
Skills
- Excellent oral and written communication
- Microsoft Office (Excel, Access, PowerPoint, Outlook, Teams)
- Staff Training
- Data modeling
- Investigate Claims
- Project management
- Problem solving
- Database Management
- Attention to detail
Accomplishments
- Used Microsoft Excel to develop inventory tracking spreadsheets.
- Created a customer service monthly digest/newsletter
Timeline
Customer Service Trainer
Elevance Health
05.2022 - Current
Cognitive Counselor
St. Brides Correctional Center
12.2019 - 05.2022
Workforce Management Analyst I
Anthem
08.2018 - 10.2019
Provider Grievance and Appeals Representative
Anthem
02.2017 - 08.2018
Enrollment and Billing Representative I
Anthem
09.2015 - 02.2017
Credentialing Associate
Anthem
07.2014 - 09.2015
Claims Representative II
Anthem
01.2009 - 07.2014
Enrollment Representative II
Anthem
12.2006 - 01.2009
Master of Science - Criminal Justice
Saint Leo University
Bachelor of Social Work - Social Work
Norfolk State University