Inika Williams

• Resolved customer follow-up items weekly by tracking requests, updating records, and closing open issues.
• Processed redetermination cases daily while maintaining timely updates and accurate case records.
• Review case details and supporting documents to confirm redetermination outcomes.
• Document customer interactions and case updates in a clear, organized format.
• Support customers by explaining redetermination steps and next actions in a professional manner.
• Monitor open items and follow up on missing information needed to continue reviews.
• Enter case information accurately into internal systems and maintain organized records.
• Use clear communication to keep customers informed throughout the redetermination process.
• Proofread case notes and correspondence for completeness before finalizing updates.
• Organize daily workload to meet service priorities and follow-up deadlines.
• Search account records to verify prior actions and identify missing details.
• Prepare routine reports and summaries using spreadsheet and document formats.

• Investigated and resolved customer issues, complaints, and account discrepancies in a timely and professional manner.
  
  Reviewed account information, transaction history, and documentation to identify the cause of reported issues.
  
  Communicated with customers by phone, email, and other channels to understand concerns and provide effective resolutions.
  
  Researched complex cases and coordinated with internal departments to resolve escalated issues.
  
  Documented customer interactions, case details, actions taken, and resolutions accurately in company systems.
  
  Followed established policies, procedures, and regulatory requirements when handling customer disputes and account concerns.
  
  Analyzed information and used problem-solving skills to determine appropriate solutions.
  
  Managed multiple cases simultaneously while meeting productivity, quality, and resolution-time goals.
  
  Escalated complex or unresolved matters to the appropriate department or management when necessary.
  
  Maintained confidentiality and protected sensitive customer and account information.
  
  Identified recurring issues and communicated trends to management to help improve processes and customer service.
  
  Provided professional, empathetic, and solution-focused customer service throughout the resolution process.

• Entered, processed, and maintained large volumes of data accurately and efficiently.
• Reviewed documents and records to verify information for completeness and accuracy.
• Updated databases, spreadsheets, and internal systems with current information.
• Performed data validation and quality checks to identify and correct errors.
• Organized, categorized, and maintained electronic and physical records.
• Processed confidential information while following company policies and data-security procedures.
• Researched discrepancies and resolved data-entry issues in a timely manner.
• Prepared reports and maintained accurate records for management and internal teams.
• Managed multiple data-processing tasks while meeting deadlines and productivity requirements.
• Communicated with team members and other departments to clarify and resolve data-related issues.
• Used Microsoft Excel, Word, and other computer applications to enter, organize, and analyze information.
• Maintained attention to detail while handling repetitive, high-volume data-processing tasks.

• Communicated service updates clearly to customers, associates, and leadership across multiple touchpoints.
• Drafted notes, logs, and follow-up documentation using Microsoft Word and Excel for accurate tracking.
• Managed high-volume service interactions calmly while addressing questions and complaints with tact.

• Receiving appeal request from providers on services that were previously denied by Medicare.
• Adjust or uphold denial of services and send out communication to the appropriate party in a timely manner. All requests are reviewed by a medical nurse and with appropriate documentation a decision is made whether to deny or approve for payment.
• Providing rendered to recipients of Medicare. CMS (Centers for Medicare and Medicaid Services) guidelines and regulations are thoroughly enforced.
• Submitting files for an appeal review by beneficiaries. These files are carefully researched and reviewed and managed in a case sensitive manner to get an accurate and correct appeal decision. Once a decision has been obtained, correspondence is then sent by mail to both parties involved (Beneficiary and Provider). All guidelines are set forth by CMS (Center for Medicare Services).

• Responsible for the processing of provider and subscriber claims (Medicare A and B processing of suspense claims and written inquires, and Medicare B query and auditing of suspense claims, adjudicating payments according to contract benefits.
• Indebt knowledge of ICD-9 diagnosis coding.
• Performed customer service duties briefly, took inbound calls from subscribers and providers assisting with benefit.