Erica Washington-Charlie
Tampa,FL
Summary
Detail-oriented and solutions-driven customer service professional with extensive experience in appeals and grievance resolution, member advocacy, and complex issue research. Recognized for strong communication skills, sound decision-making, and the ability to manage high-volume workloads while meeting strict regulatory timeframes. Adept at building rapport with members, providers, and internal partners to drive positive outcomes and process improvements.
Professional representative with robust experience and strong commitment to delivering exceptional results. Effective at collaborating within teams and adapting to changing needs to ensure reliability and success. Skilled in communication, problem-solving, and customer relations, with focus on achieving impactful outcomes. Valued for proactive approach, integrity, and ability to build lasting professional relationships.
Overview
19
19
years of professional experience
Work History
Senior Appeals & Grievance Representative
United Healthcare
12.2021 - Current
- Research, analyze, and resolve written complaints from members and providers, ensuring accurate categorization and documentation.
- Determine when clinical review is required and make clear, fact-based decisions for non-clinical appeals and grievances.
- Prepare and complete written determinations and communicate outcomes to all stakeholders within mandated timeframes.
- Collaborate with internal and external partners to ensure timely and compliant resolution.
- Investigate coordination of benefits and Medicaid claims issues.
- Support case accuracy by assisting with scrubbing and quality checks in Facets.
Navigate4Me Service Navigator
United Healthcare
02.2019 - 12.2021
- Served as a dedicated point of contact for members, resolving inquiries related to benefits, eligibility, claims, and care navigation.
- Educated members on maximizing their health plan benefits and accessing available resources.
- Provided end-to-end ownership of issues, ensuring follow-up and resolution across multiple departments.
- Conducted research on complex member concerns and partnered with support teams to remove barriers to care.
- Identified process gaps and contributed recommendations for improvement.
- Met and exceeded performance goals for call quality, efficiency, and customer satisfaction.
Customer Service Representative Lead
United Healthcare
07.2009 - 02.2019
- Assisted members with claims, benefits, provider searches, and premium EFT payment processing.
- Supported outbound campaigns and provided in-person assistance at the UHC Medicare store.
- Assisted with expedited appeals and grievance intake.
- Served as training assistant for new hire classes, providing coaching and skill development.
- Supported supervisors by handling complex callback requests and quality escalations.
Transaction Processor
JPMorgan Chase
10.2007 - 03.2009
- Investigated, processed, and reconciled customer payments.
- Responded to inquiries and handled high-priority issues with accuracy and professionalism.
- Communicated with customers via email to resolve payment discrepancies and account concerns.
Education
Diploma - undefined
Hillsborough High School
01-1998
Skills
- Customer service
- Complaint resolution
- Process improvement
- Communication
- Teamwork
- Attention to detail
Timeline
Senior Appeals & Grievance Representative
United Healthcare
12.2021 - Current
Navigate4Me Service Navigator
United Healthcare
02.2019 - 12.2021
Customer Service Representative Lead
United Healthcare
07.2009 - 02.2019
Transaction Processor
JPMorgan Chase
10.2007 - 03.2009
Diploma - undefined
Hillsborough High School