Jaliayah McDaniel
Goodyear ,AZ
Summary
Experienced Claims and Benefits Specialist with over 4 years of hands-on experience in healthcare claims processing, customer service, and collections. Skilled in interpreting benefit plans, identifying discrepancies, and resolving complex claim issues. Demonstrated ability to enhance team productivity, train junior staff, and contribute to process improvement initiatives. Strong knowledge of HIPAA compliance, fraud detection, and customer relationship management. Proven track record in fast-paced environments requiring attention to detail and cross-functional collaboration.
Overview
4
4
years of professional experience
Work History
Claims Specialist
Epiq Global
Goodyear
01.2024 - 03.2025
- Improved department efficiency by designing performance metrics and redistributing workloads for better balance.
- Trained and mentored junior claims specialists, boosting team knowledge of claims best practices and compliance standards.
- Investigated and escalated suspicious claims, reducing fraud risk and saving the company potential losses.
- Supported continuous improvement initiatives through feedback loops, process reviews, and team upskilling.
- Processed and analyzed high volumes of claims with accuracy, reducing rework rates by 15%.
- Ensured claims met regulatory and policy guidelines before submission for approval.
Credit and Collection Analyst
Cox Communications
Phoenix, AZ
02.2023 - 01.2024
- Managed inbound and outbound calls to negotiate and recover outstanding customer balances.
- Achieved consistent collection targets while maintaining high customer satisfaction scores.
- Handled sensitive financial data with accuracy and ensured proper application of payments.
- Used probing techniques to understand root causes of delinquencies and developed appropriate repayment solutions.
- Collaborated with internal departments to resolve payment discrepancies and escalated disputes.
Court Document Specialist
MetaSource
Tempe, AZ
06.2022 - 02.2023
- Handled confidential documents and digital files in compliance with HIPAA and organizational protocols.
- Scanned, indexed, and organized large volumes of client documents for fast retrieval and audit readiness.
- Maintained accurate records, managed filing systems, and ensured all revisions were properly tracked.
- Supported healthcare and legal clients by preparing high-quality records for processing or archiving.
Claims Representative
MTM
Tempe, AZ
01.2022 - 06.2022
- Analyzed and processed complex transportation-related healthcare claims.
- Resolved escalated member and provider inquiries with professionalism and accuracy.
- Maintained updated and detailed notes in claims systems for internal use and regulatory documentation.
- Improved claims cycle time by identifying and correcting documentation issues early in the review process.
- Interpreted benefit rules and coverage limits to determine claim outcomes.
Customer Service Representative
Concentrix
Tempe, AZ
08.2021 - 01.2022
- Delivered prompt and empathetic support for customer account issues, inquiries, and troubleshooting.
- Resolved billing and account concerns with a 90% first-call resolution rate.
- Provided website navigation assistance to improve customer self-service usage.
- Contributed to reduced call center wait times by following efficient call-handling procedures.
Education
High School Diploma -
Primavera Online High School
Chandler, AZSkills
- Claims Review
- Benefits Interpretation
- Fraud Detection & Investigation
- Performance Metrics Development
- Customer Communication
- HIPAA Compliance
- Call Escalation Handling
- Payment Discrepancy Resolution
- Documentation & Record Accuracy
- Cross-Functional Team Collaboration
Timeline
Claims Specialist
Epiq Global
01.2024 - 03.2025
Credit and Collection Analyst
Cox Communications
02.2023 - 01.2024
Court Document Specialist
MetaSource
06.2022 - 02.2023
Claims Representative
MTM
01.2022 - 06.2022
Customer Service Representative
Concentrix
08.2021 - 01.2022
High School Diploma -
Primavera Online High School