CHARELLE WILLIAMS
Chicago,IL
Summary
Detail-oriented healthcare and insurance professional with 7+ years of experience in member services, claims review and processing, prior authorization support, and enrollment eligibility verification. Proven ability to manage appeals, grievances, and compliance requests while ensuring HIPAA compliance and high member satisfaction. Strong communicator with excellent data entry skills and hands-on experience using Epic, Zendesk, and healthcare systems to support efficient operations.
Overview
8
8
years of professional experience
1
1
Certification
Work History
Member Service Agent
Point32Health
05.2023 - Current
- Manage member accounts, ensuring accurate enrollment and eligibility verification, PCP assignments, and demographic updates
- Support claims review and processing by documenting member inquiries, verifying coverage, and routing issues for resolution
- Assist with prior authorization requests, including intake, documentation, and status updates in accordance with plan guidelines
- Submit and track appeals, grievances, and compliance requests while adhering to regulatory requirements
- Provide benefit explanations related to claims, authorizations, and coverage determinations
- Maintain thorough documentation to support audit readiness and operational accuracy
- Build positive member relationships through active listening and timely issue resolution
Licensed Medicare Sales Agent
Connexion Point
08.2021 - 12.2021
- Assisted members in selecting appropriate Medicare plans based on healthcare needs and financial considerations
- Ensured compliance with HIPAA regulations and Medicare guidelines
- Updated member demographic and financial information, including income, address, and contact details
- Maintained in-depth knowledge of plan benefits, pricing, and competitive offerings
Medicare Member Service Agent
GoHealth
06.2019 - 08.2021
- Verified Medicare enrollment and eligibility to ensure members' coverage aligned with healthcare needs
- Assisted members with claims-related questions, copays, premiums, deductibles, and ancillary benefits
- Supported members with prior authorization guidance, explaining required steps and documentation
- Produced insurance policies when appropriate while ensuring compliance with Medicare regulations
Customer Service Representative
Advocate Medical Group
04.2018 - 05.2019
- Supported patients, providers, and healthcare staff using Epic, IDX, PerfectServe, Outlook, and symptom checker tools
- Assisted with appointment scheduling, provider paging, patient registration, medication refill requests, and inquiry resolution
- Utilized symptom checker tools to determine appropriate levels of care prior to nurse triage
- Maintained accurate logs and documentation to support clinical workflows
Education
Bachelor of Science -
Southern New Hampshire University
09.2026
Health Care Career Diploma -
Computer Systems Institute
Chicago03.2016
High School Diploma -
Zumbrota-Mazeppa Senior High School
06.2011
Skills
- Claims Review & Processing
- Prior Authorization Requests
- Enrollment & Eligibility Verification
- Appeals & Grievances
- Medical Insurance Processing
- HIPAA Compliance
- Insurance Verification
- Epic
- Zendesk
- MAX
- IDX
- Data Entry & Documentation
- Member & Patient Relations
- Medical Terminology
- Medical Billing
Certification
- CMA - Certified Medical Assistant
Timeline
Member Service Agent
Point32Health
05.2023 - Current
Licensed Medicare Sales Agent
Connexion Point
08.2021 - 12.2021
Medicare Member Service Agent
GoHealth
06.2019 - 08.2021
Customer Service Representative
Advocate Medical Group
04.2018 - 05.2019
High School Diploma -
Zumbrota-Mazeppa Senior High School
Bachelor of Science -
Southern New Hampshire University
Health Care Career Diploma -
Computer Systems Institute