ASHANTI LITTLEJOHN
Pooler,GA
Summary
Seeking a social work internship position to apply my expertise and abilities in order to create a beneficial influence on individuals and communities. As an optimistic and empathetic social work student with a background in customer service and health promotion. I am eager to gaining practical experience in a supportive and challenging internship setting that will facilitate personal and professional development.
Overview
9
9
years of professional experience
Work History
Advanced Resolution Specialist
Humana, Inc.
Louisville, KY
11.2022 - Current
- Supported members by resolving complex inquiries regarding benefits, medical and prescription prior authorization processes, and coordination of benefits issues, resulting in a 20% decrease in unresolved cases.
- Utilized active listening skills and empathy during phone interactions to resolve member concerns and improve overall customer experience.
- Obtained Subject Matter Expert and Facilitator Certification, enhancing training efficiency for new hires and supporting team cohesion for associates seeking guidance.
- Collaborated with multi-disciplinary teams to respond to high-risk member situations effectively, showcasing strong communication skills and crisis management expertise.
- Coordinate with long-term care case management to facilitate prior authorization approvals for companion care, home health services, and the Meals on Wheels program, resulting in a 15% increase in timely service delivery.
- Provided guidance on special projects and ensuring tasks were completed accurately and effectively.
- Coached and mentored associates for increased performance, resulting in higher customer service ratings.
- Participated in outreach campaign to raise awareness of the plan benefits and explained the importance of completing the health risk assessment form.
Inbound Call Center Representative 2
Humana
Louisville, KY
07.2021 - 10.2022
- Provided assistance to members regarding their state Medicaid plan, including coverage, prior authorizations, and claims, resolving average of 40 inquiries per day.
- Managed customer complaints and grievances using conflict resolution techniques to de-escalate and resolve issues
- Demonstrated proficiency in Customer Relationship Management (CRM) systems, accurately inputting notes and cases for all inbound and outbound contacts.
Risk Management Technician
City of Savannah
Savannah, GA
08.2017 - 07.2021
- Investigated and assessed damage to property and reviewed property damage estimates.
- Communicated with City Attorney, claimants, auto insurance providers, City Department Heads, and other individuals as needed to coordinate claims activities, review status work and exchange information
- Updated claims system to track claim status and provide relevant information to other department.
- Obtained evidence for each claim from multiple departments that could include video footage, to witness statements, coordinates the transmittal of claims to Gallagher Bassett under the direction of City Attorney.
- Prepared and presented detailed reports to management on claims issues to aid in decision making.
Behavioral Health Member Services Specialist
AmeriHealth Caritas
Robbinsville, NJ
10.2014 - 03.2017
- Collaborated with the NJ Department of Children and Families (DCF) and the Children's System of Care (CSOC) to enhance quality management through the examination of electronic medical records (EMR) and the resolution of issues with mental health providers
- Facilitated prior authorization and claims process with Medicaid providers
- Performed operational functions and processes as it relating to initiating registration into CSOC and acting as a first point of resolution for youth, families and health care providers
- Discussed documentation-related and level of care decisions with clients as required
- Processed HIPPA release of information requests.
Education
Master of Social Work -
Chamberlain University
Downers Grove, IL05.2026
Bachelor of Science - Public Health Education
William Paterson University
Wayne, NJ05.2013
Skills
- Customer Service
- Health Insurance
- Proficient Computer Skills
- Investigation
- Subject Matter Expert
- Behavioral Health
- De-Escalation Techniques
- Research
- Coaching abilities
- Critical Thinking
Timeline
Advanced Resolution Specialist
Humana, Inc.
11.2022 - Current
Inbound Call Center Representative 2
Humana
07.2021 - 10.2022
Risk Management Technician
City of Savannah
08.2017 - 07.2021
Behavioral Health Member Services Specialist
AmeriHealth Caritas
10.2014 - 03.2017
Master of Social Work -
Chamberlain University
Bachelor of Science - Public Health Education
William Paterson University