Andrea Williams
Ascension
Tampa,Florida
9
years of professional experience
Achieved enhanced operational effectiveness through strategic oversight of claims processing, research, and appeals management initiatives.,Drove a culture of operational excellence by implementing quality auditing practices across commercial, Medicare, Medicaid, and self-funded health plans.,Cultivated high-performing teams recognized for delivering exceptional client partnerships and results.
Work History
Claims Adjustment Supervisor
3 Years 1 Month- Direct daily operations for Senior Adjustment/Escalation Team.
- Led reduction of provider appeals inventory from 1,200+ to fewer than 100 within 3 weeks while maintaining quality and turnaround standards.
- Present KPI, quality, productivity, SLA and inventory reporting to senior leadership and external clients.
- Partner with executive leadership and cross-functional teams to resolve complex operational issues.
- Coach and develop associates through performance management and quality auditing.
Operations Claims Examiner II
1 Year 4 Months- Adjudicated complex high-dollar claims while ensuring payment accuracy.
- Performed first-touch quality audits to improve payment accuracy.
- Supported expedited claims processing, provider appeals and COB investigations.
Claims Team Lead
5 Months- Acted as subject matter expert, Led daily workflow operations, production reporting, and associate development for the Coordination of Benefits team, ensuring quality and productivity goals were achieved.
- Prepared and presented client-facing KPI, productivity, and inventory reports, providing operational insights and ensuring service level expectations were met.
- Reviewed and resolved complex Coordination of Benefits claims involving payer responsibility, ensuring payment accuracy, regulatory compliance, and timely claim adjudication.
Senior Claims Examiner
9 Months- Adjudicated complex medical claims while ensuring payment accuracy, regulatory compliance, and timely processing.
- Conducted claim reviews and resolved discrepancies involving provider billing, contract interpretation, and benefit determination.
- Collaborated with cross-functional teams to improve quality outcomes and operational efficiency.
Senior Claims Examiner
1 Year- Adjudicated complex medical claims for multiple self-funded employer groups by interpreting plan documents, member benefit summaries, and contractual provisions to ensure payment accuracy and regulatory compliance.
- Conducted first-touch quality audits of high-dollar claims, identifying payment discrepancies and reducing the need for future claim adjustments through accurate first-pass adjudication.
- Resolved complex claim issues by applying benefit plans, coding guidelines, reimbursement methodologies, and payment policies while consistently meeting productivity and quality standards.
Senior Client Advocate
1 Year 7 Months- Led client onboarding processes, ensuring seamless integration of health services and supporting systems.
- Facilitated cross-functional collaboration with internal teams to enhance client communication and service delivery.
- Analyzed client feedback to identify areas for improvement, driving initiatives that enhanced overall satisfaction.
- Streamlined claims processing workflows, reducing turnaround time and enhancing accuracy in service delivery.
- Served as primary point of contact for complex client inquiries, resolving issues effectively while maintaining strong relationships.
Education
- Digital Communications And Media
Skills
Training and mentoring
Staff management
Customer service
Analytical thinking
Claims Research
Claims Processing
Process improvement
Project management
Relationship building
Verbal and written communication
Policy and procedure development
Workflow management
Excel
Google Workspace
MS Office
Facets
HealthRules Payer
Javelina
Eldorado
Jira
Citrix
Medicare
Medicaid
Self-Funded Plans
CPT / HCPCS
Authorization Review
Timeline
Claims Adjustment Supervisor
Ascension
06.2023 - 07.2026Read More
Operations Claims Examiner II
Capital Blue Cross
02.2022 - 06.2023Read More
Claims Team Lead
BroadPath Healthcare Solutions
08.2021 - 01.2022Read More
Senior Claims Examiner
NTT DATA Services
11.2020 - 08.2021Read More
Senior Claims Examiner
Continental Benefits
03.2019 - 03.2020Read More
Senior Client Advocate
Meritain Health
06.2017 - 01.2019Read More
Full Sail University
from Digital Communications And Media
Read More