JAWANDA GOSS
South Milwaukee,WI
Summary
Highly communicative Eligibility Specialist with background helping individuals understand and access affordability options. Talented performer with over 12 years of providing information, direction and resource material. Considered team player with exemplary multitasking skills.
Overview
6
6
years of professional experience
Work History
Eligibility Specialist/Case Manager
Appleone Staffing/Our Florida
Orlando, FL
09.2021 - 05.2022
- Reviewed applications for different aid programs and determined which qualification criteria for individuals.
- Provided expert case management services for rental and utility assistance federally funded program.
- Scheduled appointments with applicants to gather information and explain benefits processes.
- Communicated directly with tenants and landlords to ensure that all application materials have been received and vetted.
- Ensured compliance with all applicable plans, policies, and standards
- Interviewed applicants and explained scope of different available benefits.
Release of Information Specialist
Verisma
Milwaukee, WI
06.2020 - 06.2021
- Process medical ROI requests in timely and efficient manner.
- Completed certifications and notarization of documents for court and legal purposes.
- Maintained accuracy, completeness and security for medical records and health information.
- Communicated effectively with staff, patients, attorneys and insurance companies by email and telephone.
- Followed exact procedures for handling transfers and other releases of medical records.
- Navigated within patient records to locate requested documentation, successfully completing over 35 requests per day.
Call Center Rep
Aurora Health Care, Tier
Milwaukee, WI
07.2019 - 07.2020
- Provided communication link between patients and caregivers through use of electronic protocols, facility information, personnel lists, and relevant department policies and procedures
- Provided support by answering non-clinical questions and resolving basic non-clinical problems
- Updated financial responsibility and other data when changes or additions occur, and communicates to patients as appropriate
- Identified emergent calls based on information provided by caller and department guidelines
- Followed process for immediate transfer to Registered Nurse for triaging or appropriate more experienced staff for resolution
- Asked clarifying questions, presents options or solutions, and escalates to more experienced staff when needed for resolution
- Maintained appropriate records for documentation
CUSTOMER SERVICE SPECIALIST
REEDGROUP MANAGEMENT LLC
Orlando, FL
07.2018 - 05.2019
- Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
- Educated customers on company systems, form completion and access to services.
- Resolved customer complaints and addressed emergency requests and needs.
- Documented and detailed calls and complaints using call center's CRM database.
- Evaluated customer information to explore issues, develop potential solutions and maintain high-quality service.
LEAVE oF ABSENCE COORDINATOR
Sedgwick Claims Management Services Inc.
Orlando, FL
07.2017 - 07.2018
- Established FMLA claims, track, and code documentation in accordance with internal workflow processes.
- Analyzed complex medical information (e.g., diagnostic tests, office notes, operative reports, etc.) to determine if claimants meet FMLA medical guidelines to determine eligibility and certification in compliance with state and federal regulations.
- Identified action plans; determined benefits due; and made timely case decisions based on service expectations as established by client.
- Clearly communicated decisions (whether approval or denial) and on‐going expectations with claimants/clients, via telephone and written correspondence regarding all aspects of claim process.
CUSTOMER SVC REP Tier 1
Sedgwick Claims Management Services Inc.
Orlando, FL
04.2016 - 07.2017
- Responded to benefit, billing, administrative questions adhering to established compliance and performance processes.
- Educated and informed customers by telephone, written correspondence and /or claim system about documentation required to process claim, payment information and claim status.
- Utilized active listening and critical thinking skills to quickly analyze and clearly understand specific request or customer need, and then leverage knowledge and resources to provide appropriate solutions.
- Acted as primary liaison with callers, followed client specifications in assisting with questions and solving problems related to claim application process.
- Collaborated with team members to achieve target results.
- Handled [75+] calls per day to address customer inquiries and concerns.
Education
Bachelor of Science - Community Engagement and Education
University of Wisconsin
Milwaukee, WI10.2021
Skills
- Active Listening and Communication
- HIPAA Regulations
- Records Management Systems
- Crisis Situations
- Team-Oriented and Cooperative
- Computer Proficiency
- Establishing and Maintaining Customer Relationships
- Cultural Awareness
- Patient and Empathetic
- Eligibility guidelines
Timeline
Eligibility Specialist/Case Manager
Appleone Staffing/Our Florida
09.2021 - 05.2022
Release of Information Specialist
Verisma
06.2020 - 06.2021
Call Center Rep
Aurora Health Care, Tier
07.2019 - 07.2020
CUSTOMER SERVICE SPECIALIST
REEDGROUP MANAGEMENT LLC
07.2018 - 05.2019
LEAVE oF ABSENCE COORDINATOR
Sedgwick Claims Management Services Inc.
07.2017 - 07.2018
CUSTOMER SVC REP Tier 1
Sedgwick Claims Management Services Inc.
04.2016 - 07.2017
Bachelor of Science - Community Engagement and Education
University of Wisconsin
Similar Profiles
Armari StewartArmari Stewart
Clerical Assistant at Appleone Staffing AgencyClerical Assistant at Appleone Staffing Agency
Jessica SanchezJessica Sanchez
Consumer and Business Affairs Representative I - Contract at Los Angeles County Board of Supervisors - AppleOne StaffingConsumer and Business Affairs Representative I - Contract at Los Angeles County Board of Supervisors - AppleOne Staffing
Rachel BreckenridgeRachel Breckenridge
Staffing Consultant at AppleOne StaffingStaffing Consultant at AppleOne Staffing
Jessica SeguraJessica Segura
Resident Care Technician-ADV at Southern Wisconsin Center for the Developmentally DisabledResident Care Technician-ADV at Southern Wisconsin Center for the Developmentally Disabled
Braiden ZwickeBraiden Zwicke
Server at Texas Roadhouse RestaurantServer at Texas Roadhouse Restaurant