Erica Williams

• Delivered compassionate, high-quality customer support to Humana members by answering questions on benefits, claims, eligibility, and enrollment.

• Assisted members with understanding Medicare Advantage, Medicare Supplement, and Prescription Drug Plans, ensuring clear communication of coverage details.

• Accurately processed policy updates, billing adjustments, and service requests while maintaining compliance with HIPAA and company guidelines.

• Resolved member concerns regarding claims and prior authorizations by collaborating with providers, pharmacies, and internal departments.

• Educated members on preventive health programs, wellness incentives, and available resources to improve overall health outcomes.

• Achieved performance metrics including call quality, first-call resolution, and customer satisfaction scores.

• Documented all interactions in Humana’s CRM system with accuracy to support future case management and auditing requirements.

• Handled high-volume inbound and outbound calls in a fast-paced environment while maintaining professionalism and empathy.

• Review, research, and resolve member and provider grievances and appeals in compliance with CMS, NCQA, URAC, HIPAA, and state/federal regulations.
• Draft accurate and professional determination, denial, and approval letters, ensuring clarity and compliance with regulatory requirements.
• Collaborate with medical directors, clinical teams, compliance, and legal departments to ensure fair and evidence-based case resolutions.
• Maintain accurate case records in [system] to support audit readiness and regulatory reporting.
• Perform root-cause analysis of escalated issues and recommend process improvements to reduce complaint volume and improve member satisfaction.
• Consistently meet or exceed departmental turnaround time (TAT) and quality assurance metrics.

• Documented customer interactions in case management systems, ensuring 100% compliance with company standards and data privacy regulations.
• Adapted to remote work environment by managing time effectively, staying self-motivated, and maintaining reliable productivity levels.
• Assisted escalated customers with problem resolution, demonstrating strong conflict management and de-escalation skills.
• Collaborated with team leads and cross-functional departments through virtual communication tools (Zoom, Teams, Slack) to resolve complex cases.

• Supervised daily restaurant operations, managing a team of 10+ employees to ensure smooth and efficient service during shifts.
• Trained, coached, and mentored staff in customer service, food safety, and company standards, reducing turnover and improving team performance.
• Monitored inventory levels, completed shift checklists, and placed supply orders to maintain stock and minimize waste.
• Handled cash management, register reconciliation, and daily deposits with 100% accuracy.
• Resolved customer complaints promptly and professionally, consistently maintaining high satisfaction scores.
• Enforced health, safety, and sanitation standards, ensuring compliance with local and state regulations.