Angelikia Wilson
Summary
Customer Service Supervisor with 10+ years of experience leading high-performing teams in healthcare and insurance environments. Expertise in escalation management, workforce optimization, and performance coaching to drive service excellence and meet SLA targets. Proven ability to analyze KPIs, identify process gaps, and implement continuous improvement strategies that enhance efficiency, compliance, and customer satisfaction. Skilled in cross-functional leadership, partnering with Operations, QA, IT, and Claims teams to resolve complex issues and improve workflows. Strong background in HIPAA compliance, quality assurance, and audit-ready documentation. Recognized for developing team talent, reducing escalations, and delivering measurable results in fast-paced, high-volume settings.
Overview
7
7
years of post-secondary education
14
14
years of professional experience
Work History
Federal IDR Operations Manager/Dispute Resolution Coordinator
Qualfon
11.2022 - Current
- Collaborated with cross-functional teams to troubleshoot complex technical problems.
- Assisted in creating training materials for ongoing staff development and support initiatives.
- Processes final payment determinations from arbitrators, reviews settlement agreements, and reconciles IDR logs
- Interfaced with internal departments to ensure timely resolution of escalated cases.
- Researched, analyzed, and resolved complex customer inquiries.
- Ensured compliance with company policies regarding security protocols.
- Educated customers about products and services to enhance satisfaction.
- Provided case management services including intake, assessment, crisis intervention, advocacy, referral and monitoring of employees.
- Developed trusting relationships with social services, health care providers and governmental agencies.
- Negotiated with insurance companies and other payers to secure coverage for client services.
- Direct NSA/IDR claims handling, Monitored initial payment and denial dates for accurate record-keeping.
- Prepare and send formal re‑opening requests, Awareness of common denial reasons, RARC/CPT/HCPCS/ICD, and provider–payor dispute dynamics
- Managing high-volume arbitration, invoices, missing docs, batch filings
- Review EOBs/ RAs and plan information to confirm NSA applicability
- Utilized case management software and databases for efficient information tracking.
Customer Support Specialist II / Healthcare Representative
Cigna
02.2017 - 10.2022
- Supported account onboarding and transitions from Sales to Support
- Managed client data, troubleshooting issues, and reporting needs
- Developed and maintained custom client reports and performance documentation to support informed decision-making.
- Utilize Salesforce and multiple internal systems to research accounts and resolve issues efficiently.
- Escalated issues appropriately while keeping clients informed; Consistent, high-quality client experiences
- Assisted members with initial enrollments, updates, and corrections while ensuring accuracy and regulatory compliance
- Verified member eligibility, demographic information, and required documentation across internal systems
- Responded to inbound inquiries via phone and email with professionalism, urgency, and empathy
- Entered and maintained detailed member records while adhering to HIPAA and confidentiality standards
- Educated members on benefits, coverage timelines, and enrollment deadlines to reduce confusion and escalations
- Coordinated with internal departments to resolve enrollment discrepancies and coverage issues
- Tracked enrollment activity and followed established SOPs to ensure timely and accurate processing
- Utilized de-escalation techniques to calmly address member concerns and enrollment-related frustrations
- Maintained thorough documentation to support audits, reporting, and quality assurance reviews
- Liaised with insurance and clinical teams to clarify eligibility requirements, preventing misrouted applications and enhancing referral accuracy.
- Established effective communication channels to ensure students received timely information. between students, faculty, advisors, and administrators.
- Assisted in implementing quality assurance measures for enrollment accuracy, contributing to improved compliance and reduced errors.
- Trained employees on best practices and protocols while managing teams to maintain optimal productivity.
Claims Enrollment Coordinator
TagMed Atlantic Group
07.2012 - 08.2014
- Assisted members with initial enrollments, updates, and corrections while ensuring accuracy and regulatory compliance
- Verified member eligibility, demographic information, and required documentation across internal systems
- Tracked enrollment activity and followed established SOPs to ensure timely and accurate processing
- Coordinated with internal departments to resolve enrollment discrepancies and coverage issues
- Educated members on benefits, coverage timelines, and enrollment deadlines to reduce confusion and escalations
- Responded to inbound inquiries via phone and email with professionalism, urgency, and empathy
- Utilized de-escalation techniques to calmly address member concerns and enrollment-related frustrations
- Entered and maintained detailed member records while adhering to HIPAA and confidentiality standards
- Maintained thorough documentation to support audits, reporting, and quality assurance reviews
- Delivered consistent, high-quality client experiences
- Coordinated with internal teams to resolve client issues efficiently
- Managed client data, troubleshooting issues, and reporting needs
- Tracked and prioritized multiple requests in fast-paced environments
- Escalated issues appropriately while keeping clients informed
- Liaised with insurance and clinical teams to clarify eligibility requirements, preventing misrouted applications and enhancing referral accuracy.
- Assisted in the implementation of quality assurance measures for enrollment accuracy.
- Developed and maintained documentation for processes and procedures.
- Trained employees on best practices and protocols while managing teams to maintain optimal productivity.
- Oversaw scheduling for team initiatives and events to optimize resource allocation. and resource allocation for team initiatives and events.
- Trained employees on best practices and protocols while managing teams to maintain optimal productivity.
Education
Master of Science - Human Resources Management
DeVry University
Illinois 11.2018 - 05.2021
BACHELOR OF SCIENCE - HEALTH SERVICE MANAGEMENT
DeVry University
Illinois 08.2014 - 05.2017
Associate of Science - Business Management Con Health Administration
Augusta Technical College
Augusta, GA 06.2012 - 05.2014
Skills
- Healthcare & Insurance Operations
- Case Management & Account Support
- Customer Experience (CX) & Client Support
- Tier 3 Escalation Management
- SLA & Queue Management
- De-escalation & Conflict Resolution
- HIPAA Compliance & Confidentiality
- Process Improvement & SOP Adherence
- Documentation & Audit Readiness
- Salesforce
- CRM & Ticketing Systems
- Portals: Sierra Health, Teleperformance, AVAILITY, Workday, BCBS over 6 states, Athena, Oscar, eClinicalWorks
- Reporting & Client Data Analysis
- Windows macOS
- SharePoint
- Microsoft Office (Excel, Word, PowerPoint, Outlook, Teams, SharePoint, Zoom)
- Time Management
- Process Improvement
- Cross-Functional Collaboration
- Team Collaboration
- Critical Thinking
- Remote Work Excellence
- Data Entry
- No Surprise Act
- Conflict Resolution
- No Surprise Act
- CRM, EPIC, UMR, UHC, SAM, OIG, ETM, Waystar, T-Drives
- Microsoft Office (Excel, Word, PowerPoint, Outlook, Teams, SharePoint, Zoom)
Timeline
Federal IDR Operations Manager/Dispute Resolution Coordinator
Qualfon
11.2022 - Current
Master of Science - Human Resources Management
DeVry University
11.2018 - 05.2021
Customer Support Specialist II / Healthcare Representative
Cigna
02.2017 - 10.2022
BACHELOR OF SCIENCE - HEALTH SERVICE MANAGEMENT
DeVry University
08.2014 - 05.2017
Claims Enrollment Coordinator
TagMed Atlantic Group
07.2012 - 08.2014
Associate of Science - Business Management Con Health Administration
Augusta Technical College
06.2012 - 05.2014