Jahzmin Coleman

• Proactively reach out to members to educate them on health plan benefits and preventive care.

• Schedule and conduct follow-ups with members to ensure continuity of care.

• Identify and address gaps in care by coordinating services and resources.

• Collaborate with case managers and providers to facilitate member care plans.

• Document member interactions and outcomes in the care management system.

• Develop and execute outreach plans to engage members in wellness programs.

• Educate members on available preventive services and chronic disease management programs.

• Identify and address social determinants of health impacting member participation.

• Track and analyze member engagement metrics to assess program effectiveness.

• Provide culturally sensitive communication to ensure diverse member engagement.

• Fraud Detection and Prevention: Identifying and investigating suspicious activities or transactions on prepaid accounts to prevent fraud
• Claims Processing: Handling and processing fraud claims submitted by customers, including gathering necessary documentation and evidence
• Customer Service: Assisting customers who report fraudulent activities on their accounts, answering their questions, and providing guidance on the claims process
• Case Management: Managing and tracking fraud cases from initiation to resolution, ensuring timely and accurate processing
• Risk Assessment: Analyzing patterns and trends in fraud cases to assess risk and develop strategies to mitigate future fraud
• Collaboration: Working with other departments, such as security, legal, and compliance, to investigate and resolve fraud cases
• Reporting: Preparing detailed reports on fraud cases, outcomes, and trends for internal use and regulatory compliance
• Training and Education: Staying informed about the latest fraud schemes and prevention techniques and sharing this knowledge with team members and other departments
• Compliance: Ensuring all activities are in compliance with Bank of America policies, as well as state and federal regulations related to fraud and consumer protection
• Documentation: Maintaining accurate records of all fraud claims and investigations, including customer interactions and evidence collected

• Case Management: Overseeing individual cases, ensuring that recipients receive the appropriate services, and coordinating care among various providers
• Eligibility Determination: Assessing and verifying the eligibility of applicants for Medicaid services based on federal and state guidelines
• Claims Processing: Handling and processing claims submitted by healthcare providers for reimbursement
• Quality Assurance: Monitoring and ensuring the quality of services provided to Medicaid recipients, including conducting audits and compliance checks
• Policy Implementation: Implementing federal and state Medicaid policies and regulations, and ensuring that these are followed by all stakeholders
• Data Management and Reporting: Collecting, analyzing, and reporting data related to Medicaid services, utilization, and outcomes
• Provider Relations: Managing relationships with healthcare providers, addressing their concerns, and ensuring they adhere to Medicaid guidelines
• Customer Service: Assisting Medicaid recipients with inquiries, appeals, and grievances related to their benefits and services
• Budget Management: Monitoring and managing the budget allocated for Medicaid services to ensure funds are used efficiently and effectively
• Outreach and Education: Providing information and resources to the community about Medicaid services and how to access them