Cayenne Wiley
Las Vegas,NV
Summary
Hardworking with a proven track record in operations, claims, and customer service. Experienced in effectively managing projects, bringing a keen eye for detail and a commitment to efficiency for timely project completion. Delivering results-driven project management solutions that contribute to organizational success.
Overview
11
11
years of professional experience
Work History
Delivery Courier
Uber
07.2023 - 04.2025
- Reduced customer complaints by providing timely updates and maintaining clear communication throughout the delivery process.
- Demonstrated a strong commitment to customer service excellence by maintaining a courteous demeanor in challenging situations and going above and beyond to ensure complete satisfaction.
Claims Analyst & HEDIS Team Lead
Clover Health
08.2019 - 07.2023
- Outbound calls to members and healthcare facilities
- Medical Records retrieval
- Led HEDIS project resulting in an increase of company's star rating from 2 to 3.
- Providing evidence and reports of KPIs to senior management on a daily basis.
- Identifying business risks and opportunity through the analysis of information and results.
- Taking full responsibility for the day to day running of all operational areas
- QA'ing employees phone calls
- Pioneered multiple comprehensive training courses for new hires.
- Streamlined tracking and resolution of medical claims using specialized software tools.
- Mitigated risk by coordinating with Senior Analysts on complex patient claims.
- Oversaw invoice workflows, prioritizing audits to maintain payment timelines and data accuracy.
- Ensured adherence to regulatory compliance guidelines and maintained HIPAA standards.
- Monitored HEDIS metrics to assess patient care and clinical outcomes.
- Reviewed and purified data to comply with contractual and government standards.
Operations Coordinator II
Aspire Healthcare
04.2016 - 11.2018
- Handled 100+ outbound and inbound calls per day
- Evaluated credential files to identify red flags.
- Ensured accuracy of information while collaborating with medical facilities.
- Regularly update patient records, including demographics, insurance, and account information.
- Documented key information for medical teams and vendors efficiently.
- Updated health records with lab results and consultation details.
Call Center Triage / Intake Coordinator
Comprehensive Pain Specialists
02.2014 - 02.2016
- Handled 100+ inbound calls per day
- Updated and maintained credential files to ensure accuracy.
- Scanned, faxed and filed documents to maintain proper office procedures.
- Processed incoming new patient referrals
Education
Medical Assistant Certification -
Nashville College of Medical Careers
Certified Nurse Assistant -
NATS
Skills
- Leadership
- Quality Assurance
- Credentialing
- Training new hires
- Medicaid / Medicare
- ICD codes
- Insurance verification
- Hosting meetings
- Auditing
- Remote Work Experience
- Records Collection
- SQL
- Claims Processing
- Microsoft Office Suite
- Customer Support (Phone/Email)
- EMR Systems
Timeline
Delivery Courier
Uber
07.2023 - 04.2025
Claims Analyst & HEDIS Team Lead
Clover Health
08.2019 - 07.2023
Operations Coordinator II
Aspire Healthcare
04.2016 - 11.2018
Call Center Triage / Intake Coordinator
Comprehensive Pain Specialists
02.2014 - 02.2016
Medical Assistant Certification -
Nashville College of Medical Careers
Certified Nurse Assistant -
NATS