Summary
Overview
Work History
Education
Skills
Timeline
Generic

Kiajaha Poole

Jacksonville,FL

Summary

Dynamic Case Manager at McKesson with expertise in patient enrollment and insurance verification. Proven track record in enhancing workflow efficiency and ensuring HIPAA compliance. Adept at high-volume data entry and fostering strong communication with healthcare providers, resulting in expedited approvals and improved patient outcomes.

Overview

7
7
years of professional experience

Work History

Case Manager

McKesson
10.2024 - 01.2025
  • Processed and maintained high volumes of patient records for specialty medications, ensuring data accuracy and compliance with HIPAA.
  • Conducted prior authorization and benefits verification by contacting insurance providers to resolve coverage issues.
  • Triaged enrollment forms and documentation according to business rules, routing items to appropriate departments.
  • Collaborated with patient support and case management teams to meet tight deadlines and program KPIs.

Claims Representative

Citizens
05.2023 - 01.2024
  • Handled workers' compensation claims with attention to regulatory compliance and financial accuracy.
  • Resolved billing discrepancies by investigating denials, offsets, and deductions with internal systems and payors.
  • Maintained up-to-date claim records and completed accurate data entries into internal claims management platforms.
  • Assisted with report generation and documentation audits to ensure operational integrity.

Fraud Prevention Representative

Nymbus
02.2022 - 04.2023
  • Reviewed and investigated complex claim records, identifying fraudulent or inaccurate submissions.
  • Interfaced with state agencies and stakeholders to resolve claim issues and discrepancies.
  • Maintained complete, real-time documentation within internal systems while adhering to data security protocols.
  • Enhanced team efficiency by implementing data tracking improvements and standardizing fraud investigation workflows.

Insurance Verification Specialist

BCForward
02.2021 - 01.2022
  • Verified insurance eligibility and processed patient records for Social Security and Medicare claims.
  • Handled documents and ensured accuracy across multiple systems for medical reviews.
  • Collaborated with healthcare providers and agencies to expedite insurance approvals and minimize delays.
  • Supported administrative efforts by completing time-sensitive tasks such as record updates, reporting, and email correspondence.

Technical Support Rep

Amazon
10.2017 - 07.2021
  • Delivered first-tier customer and technical support via phone and chat, resolving a variety of service issues.
  • Logged service tickets and troubleshooting steps into company platforms with high accuracy.
  • Maintained service quality and performance metrics in a fast-paced, remote work environment.

Education

Associate of Science - Business Administration

Florida State College At Jacksonville
Jacksonville, FL

Skills

  • Patient Enrollment & Intake
  • Prior Authorization Inquiries
  • Insurance Verification & Claims Processing
  • HIPAA Compliance & Confidentiality
  • Microsoft Office & Patient Platforms (CRMs, EHRs)
  • High-Volume Data Entry & Document Management
  • Queue Management & Workflow Optimization
  • Strong Interpersonal & Communication Skills

Timeline

Case Manager

McKesson
10.2024 - 01.2025

Claims Representative

Citizens
05.2023 - 01.2024

Fraud Prevention Representative

Nymbus
02.2022 - 04.2023

Insurance Verification Specialist

BCForward
02.2021 - 01.2022

Technical Support Rep

Amazon
10.2017 - 07.2021

Associate of Science - Business Administration

Florida State College At Jacksonville

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