Catrina Williams
Liberty,MS
Summary
Highly focused and detailed-oriented Account Manager with an exceptional record of client services. Able to manage multiple simultaneous projects with high efficiency and accuracy. Adept at working independently or managing professionals. Strong analytical skills with the ability to maintain accuracy and production standards. To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.
Overview
14
14
years of professional experience
Work History
Specialty Account Manager
CVS Caremark
07.2022 - Current
- Act as the liaison between clients and cross-functional internal teams
- Responsible for ensuring timely/successful delivery of client requests
- Demonstrate a high-level client service through the execution of accuracy, responsiveness, reliability, and professionalism on all interactions
- Managing the resolution status of routine to complex requests related to our clients' business requirements
- Engaging internal departments and client resources to work on outstanding issues from start to resolution while providing routine updates to the client
- Driving Practical & Creative Solutions for complex situations to find optimal outcome
- Discuss information at varying degrees of complexity, at varying stages of progression, and engage internal or client resources best appropriate to drive issue resolution
- Work within Deadlines and Client Guarantees
- Drive resolution within a timely manner and ensure that all Client Performance Guarantees are met.
Appeals & Grievances Supervisor
Aetna Better Health Medicaid (CVS/Aetna)
12.2020 - 07.2022
- Managed team's productivity and resources, communicates productivity expectations, and balances workload to achieve customer satisfaction through prompt/accurate handling of customer concerns
- Served as a content model expert and mentor to team regarding Aetna's policies and procedures, regulatory and accreditation requirements
- Managed to performance measures and standards for quality service and cost effectiveness and coaches the team/individuals to take appropriate action
- Participated in the staff selection process using clearly defined requirements in terms of education, experience, technical and performance skills
- Built strong functional teams through formal training, diverse assignments, coaching, mentoring and other developmental techniques
- Assessed developmental needs and collaborates with others to identify and implement action plans that support the development of high performing teams and individuals
- Ensured work of team meets federal and state requirements and quality measures, with respect to letter content and turn-around time for appeals, complaints, and grievances handling
- Held individuals/team accountable for results; recognize/reward as appropriate
- Identified trends and emerging issues and reports on and gives input on potential solutions
- Additional duties as assigned which will include a carrying a modified case load including but not limited to: Researched incoming electronic appeals, complaints, and grievance to identify if appropriate for unit based upon published business responsibilities
- Identify correct resource and reroute inappropriate work items that do not meet appeals, complaints, and grievance criteria
- Identified and research all components within member or provider/practitioner appeals, complaints and grievance for all products and services.
Senior Complaint & Appeal Analyst
Meritain Health (CVS/Aetna)
11.2016 - 12.2020
- Researched and resolves incoming electronic complaints/appeal as appropriate as a 'single-point-of-contact' based on type of appeal
- Identified and reroute inappropriate work items that do not meet complaint/appeal criteria as well as identify trends in misrouted work
- Assembled all data used in making denial determinations and can act as subject matter expert with regards to unit workflows, fiduciary responsibility and appeals processes and procedures
- Researched standard plan design, certification of coverage and potential contractual deviations to determine the accuracy and appropriateness of a benefit/administrative denial
- Reviewed all clinical determination and understand rationale for decision
- Researched all claims while processing logic and various systems to verify accuracy of claim payment, member eligibility data, billing/payment status, and prior to initiation of the appeal process
- Served as point person for newer staff in answering questions associated with claims/customer service systems and products
- Responded to Executive complaints and appeals, Department of Insurance, Department of Health or Attorney General complaints or appeals on behalf of members or providers as assigned.
Customer Service Consultant
Active Health Management (Aetna)
10.2010 - 11.2016
- Managed complex claims research scenarios and serving as a technical resource to colleagues on claim resolution, triaging of claim pre-authorization issues, and similar situations requiring senior level expertise
- Accessed information from a variety of systems and references including contracting and network system
- Explained customer/member specific plan of benefits along with member's responsibilities in accordance with contracted arrangements
- Set performance goals and establishing for the position in the areas of efficiency, call quality, customer satisfaction, first call resolution and attendance
- Provided introductory information to new customers and clients
- Enhanced the team's performance and maximize customer satisfaction by strategically managing calls and implementing process improvement
- Assisted management in ensuring performance goals are met
- Trained and mentored new staff.
Education
Master of Health Services Administration -
Strayer University
Bachelor of Business Administration -
Strayer University
Lean Six Sigma Greenbelt Certificate -
Emory University
Skills
- Excellent record in maximizing business value through comparable service solution sales
- Strong record in sound account strategy implementation
- Exceptional negotiation and leadership abilities
- High proficiency with MS Office and account management software
- Outstanding written and oral communication skills
Timeline
Specialty Account Manager
CVS Caremark
07.2022 - Current
Appeals & Grievances Supervisor
Aetna Better Health Medicaid (CVS/Aetna)
12.2020 - 07.2022
Senior Complaint & Appeal Analyst
Meritain Health (CVS/Aetna)
11.2016 - 12.2020
Customer Service Consultant
Active Health Management (Aetna)
10.2010 - 11.2016
Master of Health Services Administration -
Strayer University
Bachelor of Business Administration -
Strayer University
Lean Six Sigma Greenbelt Certificate -
Emory University