JANICE OLIVER
St. Louis
Summary
Healthcare insurance professional with 15+ years of experience in commercial and Medicaid environments, specializing in provider services, medical management support, authorization intake, and claims/eligibility resolution. Strong track record of resolving complex issues, supporting providers and members, and maintaining accurate, compliant documentation across multiple systems.
Overview
23
23
years of professional experience
Work History
Medical Management Specialist
Elevance Health
11.2021 - 03.2026
- Routed cases to appropriate departments (UM, CM, QI, Medical Review) based on clinical and non-clinical information.
- Supported authorization workflows and responded to provider inquiries.
- Acted as liaison between Medical Management, Operations, and internal teams.
- Maintained tracking systems, documentation, and reporting for case activity.
- Assisted with complex case coordination while ensuring compliance with role scope.
- Coordinated patient care initiatives to enhance service delivery and compliance.
Provider Service Advocate
UnitedHealthcare
St. Louis, MO
05.2008 - 11.2021
- Resolved provider and member inquiries related to benefits, eligibility, claims, and accounts.
- Educated members on healthcare plans, coverage options, and care navigation.
- Coordinated with provider offices to resolve issues and support care access.
- Processed authorization intake and provided preauthorization status updates.
- Researched and resolved complex cases across multiple systems.
- Met performance goals for quality, efficiency, and customer satisfaction.
Collections & Account Resolution
Afni, Inc.; Law Office of Gerald E. Moore; The May Company
01.2003 - 01.2008
- Managed delinquent accounts, negotiated payment plans, and ensured regulatory compliance.
- Worked in legal and commercial collections environments with strong documentation practices.
- Systems experience includes AS400 and account management platforms.
Education
Diploma -
Berkeley High School
01.2000
Skills
- Medical Management Support
- Benefits & Eligibility
- Case Routing
- Provider Relations
- Claims Resolution
- Regulatory Compliance
- Medicaid & Commercial Plans
- Prior Authorizations
- Documentation & Reporting
- Member Support
- Multi-System Navigation
- Issue Resolution
- Insurance verification
- EMR systems
Timeline
Medical Management Specialist
Elevance Health
11.2021 - 03.2026
Provider Service Advocate
UnitedHealthcare
05.2008 - 11.2021
Collections & Account Resolution
Afni, Inc.; Law Office of Gerald E. Moore; The May Company
01.2003 - 01.2008
Diploma -
Berkeley High School