JANEICE FAGAN
ORLANDO,FL
Summary
Dynamic professional in customer service, administration, and sales with over 12 years of experience, including three years specializing in claims management. Expertise in utilizing software such as Mitchell and ISO for precise analysis of vehicles and images, ensuring accurate fault determination in insurance accidents. Recognized for exceptional management, leadership, and communication skills, with a strong emphasis on logistics management, scheduling, and product ordering for large-scale events. Proven track record of fostering effective communication and earning client appreciation, complemented by an All Lines Adjuster license registered in Florida.
Overview
12
12
years of professional experience
Work History
Price Optimization Specialist
Zelis/Medix
11.2024 - Current
- Contributed to a cohesive team dynamic, fostering collaboration and communication among members.
- Supported strategic provider negotiations in Virginia and Texas to optimize partnership outcomes.
- Engaged with non-network providers on claims to ensure compliance with state regulations and support negotiation efforts.
- Created and maintained detailed spreadsheets and trackers to streamline price point claims management for employees and providers.
- Developed and delivered comprehensive training programs to ensure new employees understand their roles and responsibilities.
- Leveraged Outlook, Word, Excel, and OnBase to facilitate effective communication and maintain accurate documentation.
- Facilitated extraction of EOBs from Cigna to ensure accurate case documentation.
- Executed processing of arbitration-eligible medical claims to uphold regulatory standards and facilitate timely resolution.
- Coordinated mediation appointments to ensure timely and effective conflict resolution.
- Oversaw medical coding operations utilizing Compass software to ensure compliance with ICD-10, CPT, and HCPCS standards. Collaborated with healthcare teams to enhance coding accuracy and efficiency.
- Cultivated a structured and purposeful work environment aimed at empowering others to achieve their goals.
Revenue Cycle Management - Claims
Vaxcare/Tews Co
Orlando
09.2023 - 04.2024
- Oversaw financial operations and billing processes to enhance revenue cycle efficiency in healthcare.
- Implemented strategies to streamline revenue processes, resulting in reduced denials and improved cash flow.
- Implemented revenue cycle best practices to optimize financial performance and operational efficiency.
- Analyzed industry trends to identify potential issues and mitigate claims risks.
- Facilitated resolution of team conflicts during financial analysis meetings. Led organizational initiatives to drive discussions on financial performance. Championed collaborative efforts to strengthen teamwork in financial assessments.
- Conducted outbound calls to primary insurance, aiming to resolve eligibility denials and streamline claims handling.
- Facilitated effective customer service interactions to swiftly address and resolve client issues.
- Managed medical coding and billing operations to facilitate timely payment completion.
- Utilized Microsoft Office to create and manage daily spreadsheets and email communications for efficient workflow.
- Oversaw implementation of EMR systems, including Availity and RealMed, to optimize patient information processes. Guided teams in leveraging electronic medical records for improved operational effectiveness. Championed training initiatives to elevate staff competency in EMR usage.
- Oversaw data entry processes to enhance accuracy and efficiency. Coordinated with team members to streamline data management practices. Implemented best practices for data integrity and organization.
Adjuster - Claims
Progressive
Remote
01.2020 - 03.2023
- Guided customers in navigating claims procedures while educating them on potential resolutions.
- Facilitated prompt investigations in collaboration with special investigations and legal departments to address warranted claims.
- Analyzed incoming files and established injury claim statuses to devise effective response strategies.
- Managed and organized email communications from shop customers and colleagues to support efficient claims processing and resolution efforts.
- Engaged with repair facilities in Mitchell to facilitate resolution of vehicle damage.
- Utilized knowledge of ISO, Mitchell, PD Suite, and Accurint to support data analysis and decision-making processes.
- Analyzed evidence to facilitate positive client results.
- Collaborated with Business to meticulously examine images, facilitating unbiased claim resolutions.
- Coordinated with team members to identify and communicate updates and obstacles faced during claims handling.
- Oversaw data entry operations to enhance accuracy and efficiency. Coordinated with team members to streamline processes and improve data management practices. Developed strategies to optimize data entry workflows and reduce errors.
- Achieved timely project completions by leveraging strong analytical capabilities. Enhanced operational efficiency through effective multitasking and prioritization. Drove team performance by implementing streamlined processes for task management.
- Followed established guidelines to ensure compliance with laws and regulations in all activities.
- Oversaw customer service operations to improve response times and service quality. Developed training programs for staff to enhance customer interaction skills. Implemented feedback mechanisms to drive continuous improvement in service delivery.
- Analyzed claims to determine coverage and liability, supporting compliance with policy standards.
- Engaged with clients to obtain required documentation, ensuring accuracy in claim processing.
- Facilitated collaboration among diverse teams to refine claims processes, aiming to elevate customer satisfaction.
- Investigated and assessed property damage, and reviewed property damage estimates.
Team Lead
Alorica
Tampa, FL
09.2017 - 02.2020
- Achieved improved customer satisfaction by effectively managing inbound and outbound calls and supporting 20 team members with escalated inquiries. Enhanced productivity and customer service ratings through targeted performance reviews.
- Led teams in implementing streamlined processes and procedures. Facilitated organization of document workflows to enhance call efficiency. Oversaw customer escalations to ensure timely resolutions.
- Conducted thorough reviews of calls to ensure compliance with established policies and procedures.
- Oversaw data entry operations to enhance accuracy and efficiency. Coordinated with team members to streamline data management processes. Implemented best practices for data integrity and organization.
- Partnered with leadership to develop and execute streamlined strategies aimed at enhancing customer issue resolution.
- Collaborated with employees to streamline international logistics processes and address customer complaints effectively.
- Managed payroll processes while analyzing employee work contributions against company goals.
- Managed work productivity of employees to ensure compliance with quality analyst evaluation criteria.
- Oversaw workforce restructuring initiatives during mass layoffs. Coordinated with HR to implement support programs for impacted employees. Developed communication strategies to ensure clarity and transparency throughout the process.
Customer service /Lead - II
Centene
Orlando, FL
02.2014 - 09.2017
- Oversaw customer service operations for Medicaid, facilitating connections between clients and healthcare professionals to enhance treatment access. Managed inquiries regarding specialty physician referrals to improve patient outcomes. Developed strategies to streamline communication between clients and providers.
- Implemented effective de-escalation techniques to support individuals confronting intense suicidal thoughts.
- Coordinated case load activities, prioritizing tasks to meet client needs efficiently.
- Administered payment handling for healthcare policies to ensure timely and accurate transactions for dental and vision services.
- Guided team members in enhancing their professional skills and career growth within the organization. Led team meetings to foster effective communication and collaboration. Conducted thorough reviews of medical records to ensure accuracy for coding and database management.
- Facilitated case delegation processes to enhance revenue management efficiency.
- Led initiatives to enhance retention rates by implementing employee development programs. Oversaw diversity hiring strategies to foster an inclusive workplace. Achieved corporate staffing goals through strategic workforce planning.
- Oversaw data entry processes to enhance accuracy and efficiency. Coordinated with team members to streamline data management practices. Implemented best practices for data organization and retrieval.
- Addressed payment inquiries and reconciled outstanding statement balances to enhance customer satisfaction.
- Facilitated de-escalation of calls to provide support and reassurance to distressed individuals.
- Provided secure guidance to customers to improve their overall experience.
- Facilitated customer understanding of safety measures in everyday activities.
- Provided guidance on interpreting medical prescriptions and appropriate dosage applications to ensure patient safety.
- Directed team responsibilities and evaluated call interactions to foster a secure environment for customers.
- Coordinated meeting arrangements and resolved office challenges to support team collaboration.
Media Director and Logistics Manager
TIMS Service
Orlando, FL
01.2024 - Current
- Conducted comprehensive financial analysis on a daily basis to support informed decision-making.
- Performed calculations for daily business accounting to maintain financial integrity.
- Crafted comprehensive PowerPoint presentations and mission statements to facilitate direct planning for achieving company financial goals.
- Facilitated prompt call responses while coordinating and organizing calendar meetings to optimize time management.
- Created and formatted Excel spreadsheets and Microsoft program files to enhance data management.
- Coordinated and organized meetings and conference calls to support business negotiations and staff communication.
- Provided comprehensive customer service through effective handling of inbound and outdoor calls to enhance client satisfaction.
- Facilitated recruitment processes to effectively fill corporate and start-up positions across all levels of responsibility.
- Managed payroll processes to align employee compensation with company goals and performance metrics.
- Monitored and evaluated employee performance to support team objectives.
- Developed and implemented effective methods to enhance productivity and support sustainable growth initiatives.
- Conducted comprehensive analysis of market trends to support informed strategic decisions and optimize content distribution channels.
Education
Bachelor of Science - Business Entertainment, Marketing development, Psychology Of Play
Full Sail University
Orlando, FL12-2027
Associates Degree - Studies
Valencia College
01.2012
High school -
Lake Howell High School
06.2009
Skills
- Efficient typing skills at 45 WPM
- Effective multitasking
- Reliable team member
- Skilled in effective communication
- Collaborative decision-making
- Effective data management techniques
- Research adaptability
- Crisis management expertise
- Scheduling techniques
- Cost reduction strategies
- Attention to detail
- Reliability
- Task prioritization
- Self motivation
Languages
English
Native or Bilingual
Timeline
Price Optimization Specialist
Zelis/Medix
11.2024 - Current
Media Director and Logistics Manager
TIMS Service
01.2024 - Current
Revenue Cycle Management - Claims
Vaxcare/Tews Co
09.2023 - 04.2024
Adjuster - Claims
Progressive
01.2020 - 03.2023
Team Lead
Alorica
09.2017 - 02.2020
Customer service /Lead - II
Centene
02.2014 - 09.2017
Bachelor of Science - Business Entertainment, Marketing development, Psychology Of Play
Full Sail University
Associates Degree - Studies
Valencia College
High school -
Lake Howell High School
Independent Endeavors
- Amway
- JBO program. – Orlando, FL 2010 -2013
- Selling eco friendly products.
- Familiarizing with a wide range of testing products.
- Candidate evaluation with products, resulting in sales.
- Using salesforce.
- Mentorship / training of candidates.
- Ensure quality client care with sensitive information by following and enforcing HIPPA laws.
- Successfully staffed corporate and start-up positions from the entry to supervisory level.
- Plan, organize, and execute healthy productive methods for company growth and profit.
CIVILIAN EXPEREIECE
- (SELF EMPLOYED) - ARTIST MANAGEMENT
- Managing artist appearance.
- Email marketing.
- Scheduling performances, studio sessions, creative directing.
- Videography / Directing, script writing.
- Media preparation.
- Content creation and social media management.
- Schedule creation using Calendly, Zoom, Calendar, Set more, Gloss.
- Genius Meetings with pristine collaborators, to create content.