Jakeima Williams

Assisted member with verification of new benefits, assist pharmacist with claims inquiries and override rejected claim. Provide physician and nurse with prior authorization status. Send and fax forms to initiate prior authorization.

Check updates with the plan and 3rd party cover my meds with eligibility dates and coverage verification.Processed coverage determination request. Resolved customer

complaints and concerns maintaining a high level of customer satisfaction.

Collaborated with internal teams to ensure accurate claim processing and

resolution of complex inquiries. Adhered to HIPAA regulations, maintaining

confidentiality of sensitive health and financial data. Maintain a high call volume

while ensuring compliance with Medicare guidelines.

• Assisted Medicare beneficiaries with enrollment, claims inquiries, and status updates on Medicare coverage. Processed Medicare applications, claims, and appeals, ensuring timely and accurate completion. Resolved customer complaints and concerns maintaining a high level of customer satisfaction. Collaborated with internal teams to ensure accurate claim processing and resolution of complex inquiries. Adhered to HIPAA regulations, maintaining confidentiality of sensitive health and financial data. Maintain a high call volume while ensuring compliance with Medicare guidelines.

• Direct management of claims including the investigation, analysis and evaluation of coverage liability and damages, within best practices Providing technical advice, training and guidance to direct reports and TPA/Contractor adjusters including strategic direction. Recruiting, hiring and retaining top talent and developing appropriate succession plans. Reviewing claims to determine nature of loss, coverage provided, and scope of claim and guide strategies for direction regarding settlement/disposition of claims.