Cierra Wilson
Redford,MI
Summary
Capable Analyst with proven history of enhancing operations. Proficient in best practices, leadership strategies and employee motivation to boost productivity and job performance. Well-coordinated in addressing problems, investigating root causes and implementing successful resolutions.
Overview
8
8
years of professional experience
Work History
Senior Analyst
Blue Cross And Blue Shield Of Michigan
Detroit, MI
02.2020 - Current
- Analyzed large amounts of data to identify trends and find patterns, signals and hidden stories within data.
- Used business objects, business intelligence and other reporting tools to extract data from data solutions and data warehouses.
- Performed root-cause analysis on data-related system problems to recommend or execute corrective action.
- Liaised between the MA Servicing department and Medicare Claims Operations team
- Supported and aligned efforts to meet business and customer needs
- Managed customer relations by developing effective communications process and updating currently active processes.
- Boosted information sharing by enhancing interfaces between computer systems.
- Coding Knowledge and experience with ICD-10, CPT, HCPCS, Revenue, DRG and other relevant medical and industry- standard codes.
- Advanced experience in benefits/ claims in Ika systems.
- Researched and analyzed claims to ensure claims processing was aligned with CMS guidance.
- Project SME for MA and BCNA as it relates to Clinical Editing and Cotiviti Software updates.
- Working with Provider Consultants by handling manager escalated claim and payment issues for resolution.
- Ability to handle multiple projects while still maintaining my daily tasks and prioritizing work based on deadlines.
- Discovered root causes of problems and identified appropriate solutions.
- Performed quality assurance to meet appropriate standards and facilitate improvement of processes.
Analyst
Blue Cross Blue Shield Of Michigan
Detroit, MI
03.2019 - 02.2020
- Researched and recommended process improvements designed to mitigate operational risk in customer service
- Provided reporting in support of decision-making
- Responsible for providing daily reporting metrics for multiple Medicare Advantage clients
- Validated results and performed quality assurance to assess accuracy of data
- Collaborated with management to build and implement effective and efficient policies
- Documented procedures and business processes and shared information with appropriate stakeholders
- Maximized team knowledge and productivity by effectively training, monitoring and directing employees in application of best practices and regulatory protocols
- Represent the department on work groups and special assignments
- Review and respond to customer service inquiries
Customer Service Representative
Blue Cross Blue Shield of MI
Detroit, MI
08.2014 - 03.2019
- Manage Medicare Advantage customer calls effectively and efficiently in a complex, fast-paced and challenging call center environment
- Provided customers with important details about premium billing, eligibility and claims processing
- Utilize ika gateway/ Enterprise to resolve customer inquiries and complaints in a timely and empathetic manner
- Review alerts, MI Source, and other documentation to properly respond to inquiries
- Investigated issues to determine appropriate coverage and liability for claims
- Analyze claims and identify system issues for troubleshooting and corrective action
- Received multiple positive reviews which acknowledged dedication to excellent customer service
- Developed reputation as an efficient service provider with high levels of accuracy
- Instrumental in multiple claims projects. Including acting as provider consultant liaison to assist Medicare Advantage providers in claim resolution
- Review and respond to provider written claims inquiries
Education
Diploma -
John Glenn High School
Westland, Michigan2012
Skills
- Skilled in call center operations
- Adheres to customer service procedures
- Strong problem solving aptitude
- Persuasive speaker
- Creative problem solver
- Extensive knowledge of CMS policies/guidance
- Extensive knowledge of Medicare Advantage products
- Experienced in utilizing Medicare Advantage systems: Ika Systems, NCompass, and Blue Squared
- Spreadsheet Development
- Business Operations Knowledge
- User Acceptance Testing (UAT)
- Critical Thinking
- Data mining and Analytics
Timeline
Senior Analyst
Blue Cross And Blue Shield Of Michigan
02.2020 - Current
Analyst
Blue Cross Blue Shield Of Michigan
03.2019 - 02.2020
Customer Service Representative
Blue Cross Blue Shield of MI
08.2014 - 03.2019
Diploma -
John Glenn High School
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