EARTHA JACKSON
Summary
Experienced with program service evaluation, delivering in-depth analysis and actionable insights. Utilizes critical thinking and attention to detail to assess program performance. Track record of effective communication and collaboration with cross-functional teams, ensuring program objectives are met.
Overview
10
10
years of professional experience
Work History
Program Service Evaluator 3
Department of Economic Security/Division of Employment & Rehabilitation Services
04.2020 - Current
- Work in UI DERS unemployment area.
- Responsibilities to include locating and identifying overpayments made to DES clients, ensuring all necessary forms sent out to claimant to complete and return.
- Compete and updated spreadsheets and make outbound calls to claimants, employers and human resources concerning verification of job-related issues.
- Makes decisions and takes course of action in reviewing information.
- Check on whether cases are fraud related.
- Also take phone calls from claimants' regarding overpayments, missing benefits, etc...
TPL/Claims Specialist II
Department of Economic Security/Division of Developmental Disabilities
10.2017 - 04.2020
- Involved in handling third party billing for the state disabilities Claims division.
- Organizes and prioritizes multiple tasks daily including reversals and voids, work closely with providers to assist in processing their claims, input waivers per provider's request.
- Obtains verification of insurance via telephone and communicates regularly with providers in handling all requests.
Claims Specialist II (temp)
Randstad - Department of Economic Security/Division of Developmental Disabilities
04.2017 - 10.2017
- Involved in handling third party billing for the state disabilities Claims division.
- Organizes and prioritizes multiple tasks daily including reversals and voids, work closely with providers to assist in processing their claims, input waivers per provider's request.
- Obtains verification of insurance via telephone and communicates regularly with providers in handling all requests.
Medical Review Specialist
TriWest Healthcare Alliance
07.2016 - 11.2016
- Reviewed authorizations to correct and prepared medical documents for procedures, entered service codes for payment of third-party billing.
- Communicate via email medical review nurse information regarding utilization management and recorded length of stay for inpatient hospital stays.
Claims Specialist/Behavioral Health/AHCCCS
Aetna Insurance
12.2014 - 04.2016
- Fast past environment of processing up to sixteen mental health AHCCCS claims per hour within an 8-hour shift, assisted providers with billing concern and provided resolution, tracked claims from CICR department.
- Managed Michigan claims that were a new market that Aetna had acquired.
- Worked with UB/HFCA claim forms.
- Consistently following protocol of state and federal regulations.
- This was a problem-solving and strategical position, using analytical skills reviewing claims thoroughly.
- Worked with dual states analyzing claims.
Education
Various college courses - Health Information Technology
Gateway Community College
Phoenix, AZ01.2017
Various college courses - Medical Terminology & Communications
Phoenix College
Phoenix, AZ03.2016
Associate degree - Business Administration and Accounting
Cincinnati Metropolitan College
Cincinnati, OH01-1983
Skills
- Advanced Excel proficiency
- Proficient in Microsoft Office
- Google Workspace proficiency
- Utilizing monitoring tools
- Diverse program management
- Knowledge of state programs
- Effective written communication
- Effective verbal communication
- Effective time management
- Analytical problem solving
Accomplishments
- CPI Blue Card Certificate, State of Arizona Dept. of Safety
- Fingerprint Clearance Card
- Trainer for Prudential Insurance, 01/15, 12/15, Set up contracts in the PDS department for different insurance plans over the Aetna market across the nation., Phoenix, AZ
- Customer Service Award, 06/03, Received best customer service award from Office Depot., Phoenix, AZ
- Transferred from Magellan, 09/07, Transferred to Phoenix, AZ to help with the start-up of Magellan in Phoenix., Cincinnati, OH
- New supervisor position in Home Care, 01/80, 12/82, Selected as new supervisor for four personnel at a janitorial business., Cincinnati, OH
Timeline
Program Service Evaluator 3
Department of Economic Security/Division of Employment & Rehabilitation Services
04.2020 - Current
TPL/Claims Specialist II
Department of Economic Security/Division of Developmental Disabilities
10.2017 - 04.2020
Claims Specialist II (temp)
Randstad - Department of Economic Security/Division of Developmental Disabilities
04.2017 - 10.2017
Medical Review Specialist
TriWest Healthcare Alliance
07.2016 - 11.2016
Claims Specialist/Behavioral Health/AHCCCS
Aetna Insurance
12.2014 - 04.2016
Various college courses - Medical Terminology & Communications
Phoenix College
Various college courses - Health Information Technology
Gateway Community College
Associate degree - Business Administration and Accounting
Cincinnati Metropolitan College
Similar Profiles
Thomas DunklinThomas Dunklin
Inventory Specialist at Department of Economic Security Child and Community Services DivisionInventory Specialist at Department of Economic Security Child and Community Services Division
Valentin VakebilaValentin Vakebila
Benefits Specialist (Remote) at Employment Security Department/ LCD DivisionBenefits Specialist (Remote) at Employment Security Department/ LCD Division
Corinn PilbroCorinn Pilbro
Adjudicator at WA State Employment Security Department Leave and Care DivisionAdjudicator at WA State Employment Security Department Leave and Care Division
ALEXIS D. MUNOZALEXIS D. MUNOZ
Adjudication Program Evaluator 3/ Benefits & Eligibility Specialist at AZ DES UnemploymentAdjudication Program Evaluator 3/ Benefits & Eligibility Specialist at AZ DES Unemployment
Megan FrenchMegan French
Program Service Evaluator III at Arizona Department of Economic SecurityProgram Service Evaluator III at Arizona Department of Economic Security