Janika Collins
Memphis,TN
Summary
Successful EDI Analyst, accustomed to researching issues, analyzing data, and evaluating system performance. Enthusiastic, adaptable, and resourceful, with vast administrative and business experience. Proven ability to implement, monitor, and maintain EDI software solutions while adhering to industry standards. Strengths include problem-solving skills, technical acumen, and ability to work collaboratively in fast-paced environments.
Overview
3
3
years of professional experience
Work History
EDI TECHNICIAN
MUTUAL OF OMAHA
06.2024 - Current
- Independently manage EDI eligibility and enrollment activity for approximately 8,100 covered lives across 280 employer groups, operating in a fast-paced environment that requires daily prioritization, sound judgment, and minimal oversight
- Analyze and process 600-style flat files and XML-formatted EDI files, applying detailed benefit eligibility rules, underwriting logic, and plan provisions to ensure accurate member enrollment, termination, and coverage updates.
- Reconcile enrollment data across EDI files, GSAP, and the Compass billing system to confirm proper enrollment, prevent billing and coverage errors, and protect revenue and client trust.
- Perform hands-on unenrollment, reenrollment, and coverage corrections, identifying root causes of discrepancies, and resolving issues before they impact billing, claims, or member experience.
- Partner with Business Analysts and cross-functional teams through Jira, clearly documenting issues, explaining system behavior, and contributing operational insight that supports effective requirements gathering and resolution.
- Educate TPAs and employer groups on benefit eligibility, enrollment timing (OE vs. AIO), EOI requirements, and system behavior, serving as a subject-matter resource and reducing repeat errors.
- Monitor enrollment trends and recurring issues across assigned groups, effectively performing case-management–style oversight to maintain data accuracy, compliance, and operational consistency.
- Translate complex enrollment and eligibility rules into clear, business-friendly explanations for internal and external stakeholders, demonstrating strong communication and analytical skills.
CUSTOMER CARE ANALYST III
MUTUAL OF OMAHA
09.2023 - 06.2024
- Managed 50-80 inbound calls daily, providing expert support to policyholders, providers, and Medicare supplement callers regarding a range of topics including billing, policy details, claims inquiries, and coverage questions for both active and inactive health insurance policies.
- Delivered high-level technical support, troubleshooting user access issues with the company's online portal, assisting policyholders and providers with password recovery, login difficulties, and account access, ensuring a seamless digital experience.
- Effectively resolved billing discrepancies and handled inquiries related to Medicare supplement claims, ensuring accurate and timely billing resolution through clear communication and problem-solving.
- Provided detailed assistance to callers regarding claim status, coverage options, and benefits, offering personalized guidance and clarification to ensure full understanding of policy terms and conditions.
- Executed policy terminations and conducted thorough follow-up, ensuring all necessary documentation was sent, including Power of Attorney (POA) and provider information, while maintaining accurate records for reporting and auditing purposes.
- Collaborated with internal teams to resolve complex issues and process claims, ensuring that all actions were tracked in a CRM system for accuracy and up-to-date client information.
- Prioritized customer satisfaction and compliance with industry standards while maintaining a focus on efficient call handling and issue resolution in a fast-paced, high-volume environment.
REALTOR
KELLER WILLIAMS REALTY
09.2022 - 09.2023
- Recorded and maintained accurate property listing information, including details such as property specifications, pricing, and availability, utilizing various databases and software systems.
- Entered client information, transaction details, and contractual agreements into electronic databases with precision and efficiency, ensuring data integrity and compliance with legal requirements.
- Generated reports, spreadsheets, and documents to track property listings, client interactions, and sales transactions, demonstrating proficiency in data organization and management.
- Conducted research and analysis to gather market data and trends, inputting findings into databases to support informed decision-making processes for clients and colleagues.
Education
Associate of Applied Science - Business Data Analytics
California Institute of Applied Technology
San Diego, CASkills
- Business requirements and systems analysis
- Data analysis, validation, and reconciliation
- XML and 600-style flat file analysis
- Eligibility, enrollment, and plan rule interpretation
- Coverage determination and benefits compliance
- Jira (ticketing, issue tracking, and BA collaboration)
- Stakeholder communication and employer/TPA education
- Process improvement and operational optimization
- Microsoft Excel (data review and reporting)
Timeline
EDI TECHNICIAN
MUTUAL OF OMAHA
06.2024 - Current
CUSTOMER CARE ANALYST III
MUTUAL OF OMAHA
09.2023 - 06.2024
REALTOR
KELLER WILLIAMS REALTY
09.2022 - 09.2023
Associate of Applied Science - Business Data Analytics
California Institute of Applied Technology