JAQUETTA MACK
Tampa,FL
Summary
Analytical Problem Solver experienced in interviewing claimants, compiling records, and documenting findings. Achieved operational efficiency improvements by streamlining reconciliation processes and resolving discrepancies through strong analytical skills and attention to detail. Focused on delivering exceptional customer service and fostering collaboration in team-oriented environments.
Overview
9
9
years of professional experience
Work History
Reconciliation Analyst
Convey Health
Tampa, Florida
10.2025 - Current
- Reviewed account statements to identify and resolve variances efficiently.
- Analyzed financial discrepancies in reconciliation processes for healthcare services.
- Utilized reconciliation software to streamline data processing and reporting.
- Collaborated with cross-functional teams to improve reconciliation workflows.
- Prepared documentation for audits and compliance reviews within the organization.
- Reviewed data entry into accounting system for accuracy prior to posting.
- Documented processes for reconciliation procedures that were developed or modified.
- Participated in training sessions on new software applications related to reconciliation tasks.
Customer Service Representative
LIBERTY Dental Plan
01.2025 - 04.2025
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Enhanced customer satisfaction by promptly addressing concerns and providing accurate information.
- Handled escalated calls, resolving issues to ensure customer satisfaction and uphold company standards.
- Responded to customer inquiries regarding products and services, delivering accurate information to meet their needs.
- Developed strong product knowledge to provide informed recommendations based on individual customer needs.
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Maintained detailed records of customer interactions, facilitating effective follow-up and issue resolution.
Claims Representative
Humana Military- Tricare East
04.2023 - 10.2023
- Responsible for administering claims payments, maintaining claim records
- Collaborated with physicians and patient care providers on billing and documentation policies, enhancing compliance and understanding of regulations
- Manage all aspects of insurance billing and processing including claim review and correction
- Coordinated referral process by processing incoming and outgoing referrals and prior authorizations, ensuring timely service delivery and patient care continuity
- Provided triage and care coordination for non-clinical assessment cases.
- Resolved provider inquiries and issues, improving communication and satisfaction with claims process
- Administered claims payments and maintained claim records.
- Monitored and controlled backlog and workflow of claims.
- Maintained a detailed understanding of the organization's payer mix and reimbursement rates, providing key insights during budget planning or forecasting discussions
Member Relationship Specialist II
WellCare/Centene
04.2020 - 10.2022
- Resolve customer inquiries via telephone and written correspondence in a timely and appropriate manner
- Reference current materials to answer escalated and complex inquiries from members and providers regarding claims, eligibility, covered benefits and authorization status matters
- Educated members and providers on health plan initiatives while facilitating first call resolution through collaboration with internal and external resources
- Document all activities for quality and metrics reporting through the Customer Relationship Management (CRM) application
- Process written customer correspondence and provide the appropriate level of follow-up in a timely manner
- Researched and pinpointed processing inaccuracies in claim payments, routing issues to the appropriate team for timely adjustments
- Identified trends in member and provider inquiries to recommend policy or process improvements enhancing customer service and quality standards
- Maintain performance and quality standards based on established call center metrics including turn-around times
- Work with other departments on cross functional tasks and projects
- Processed and sent requested materials via mail or fax to ensure timely delivery to recipients.
Scheduling Specialist/Customer Service
Physician Partners of America
10.2019 - 05.2020
- Handled emails, inbound calls, and outbound calls
- Assisted customers with a warm and professional attitude
- Managed emails, inbound calls, and outbound calls to ensure timely customer support
- Handled billing issues and order inquiries
- Managed customer accounts
- Booked appointments
- Documented and tracked customer complaints to identify trends and improve service
- Created patient charts to organize medical information.
- Mailed patient packages to provide necessary information.
Claims Denials & Follow-Up Rep - Revenue Cycle
Orlando Health Hospital
07.2017 - 02.2019
- Follow up on unpaid claims to the point of payment or resolution of the claim, and resolve credit balances
- Resolved all outstanding insurance account receivables.
- Completes full-cycle insurance billing operations for and acts as the primary point of contact for5-7 client accounts
- Completed full-cycle insurance billing operations and served as primary contact for 5-7 client accounts
- Submits claims in a timely fashion and reviews outgoing claims before submission to identify errors and potential rejections Processed insurance and patient refunds.
Education
High School Diploma -
Hillsborough High School
Tampa, FLSkills
- Claims processing experience
- Claims management
- Reconciliation processes
- Accuracy and Precision
- Data processing
- ICD-10 Coding Familiarity
- Medical Appeals
- Handling Insurance Verification
- HIPAA Compliance Knowledge
- Medicare and Medicaid knowledge
- Benefit Coverage
- Eligibility Determination
- Claims analysis
- Utilization Review Experience
- Billing Software
- Compliance understanding
- Insurance billing
- Records Maintenance
- Call Center Operation remotely
- Data entry
- Teamwork and Collaboration Dispute Resolution Relationship Management
- Client Relations
- Conflict resolution
- Dispute Resolution
- Teamwork and Collaboration
- Issue Research
- Microsoft Office
- Conflict resolution
Languages
English
Timeline
Reconciliation Analyst
Convey Health
10.2025 - Current
Customer Service Representative
LIBERTY Dental Plan
01.2025 - 04.2025
Claims Representative
Humana Military- Tricare East
04.2023 - 10.2023
Member Relationship Specialist II
WellCare/Centene
04.2020 - 10.2022
Scheduling Specialist/Customer Service
Physician Partners of America
10.2019 - 05.2020
Claims Denials & Follow-Up Rep - Revenue Cycle
Orlando Health Hospital
07.2017 - 02.2019
High School Diploma -
Hillsborough High School