KIJAI BELL
Midlothian,IL
Summary
Results-driven healthcare operations and compliance professional with over 7 years of experience in contract review, quality auditing, and business process improvement. Skilled in analyzing complex requirements, evaluating operational impacts, and developing effective implementation strategies. Expertise in supporting enterprise initiatives within highly regulated environments and translating intricate needs into practical solutions.
Overview
2
2
years of post-secondary education
8
8
years of professional experience
Work History
Coordinator
Health Care Service Corporation (HCSC)
04.2023 - Current
- Review operational processes and contractual requirements to ensure alignment with business obligations, organizational standards, and healthcare policies.
- Conducted quality audits and call reviews to assess compliance and identify operational risks, resulting in actionable recommendations for process improvements.
- Performed root cause analysis on complex operational issues, recommending corrective actions that enhanced compliance and operational efficiency.
- Support audit readiness activities through process reviews, documentation validation, and operational assessments.
- Develop procedural documentation, implementation guidance, business communications, and training resources supporting operational initiatives.
- Facilitated cross-functional discussions among business stakeholders, leadership, and technical teams to support successful implementation of operational initiatives.
- Partner with leadership, development specialists, and technical teams to support implementation of system enhancements and operational changes.
- Analyze the impact of business, system, and process changes and provide guidance to leadership and operational teams.
- Established and maintained audit review processes that enhanced identification of compliance risks, operational gaps, and quality concerns.
- Serve as a subject matter expert on benefits administration, claims processes, and operational procedures.
- Designed, developed, and launched a centralized SharePoint knowledge management platform from inception, creating a single source of truth for operational procedures, training materials, implementation guidance, and business updates.
- Supported implementation of business and operational changes by ensuring alignment between contractual requirements and operational processes.
Customer Advocate Specialist
Health Care Service Corporation (HCSC)
08.2022 - 04.2023
- Conducted research and analysis of complex member and provider issues to interpret policies, benefits, and operational requirements, enhancing issue resolution.
- Conducted comprehensive research and analysis of complex member and provider issues requiring interpretation of policies, benefits, and operational requirements.
- Collaborated across departments to ensure consistent application of policies, procedures, and business requirements.
- Collaborated across departments to align application of policies and procedures, improving consistency and compliance.
- Identified systemic process concerns and proposed operational improvements, contributing to enhanced service delivery.
Customer Service Representative II
Health Care Service Corporation (HCSC)
02.2021 - 08.2022
- Interpreted healthcare benefits and policy requirements for members and providers, ensuring clear understanding and compliance.
- Analyzed customer concerns and resolved complex issues involving claims and eligibility, enhancing customer satisfaction.
- Maintained compliance with HIPAA requirements and organizational policies.
- Assisted in implementation and communication of policy updates, facilitating smoother transitions for team members.
Claims Analyst
Health Care Service Corporation (HCSC)
05.2020 - 02.2021
- Reviewed and analyzed medical claims to ensure compliance with benefit plans, contractual provisions, and business rules, enhancing claim processing accuracy.
- Conducted detailed investigations to determine claim accuracy and appropriate adjudication outcomes.
- Applied healthcare policies and contractual requirements when evaluating claim determinations.
- Identified discrepancies and facilitated resolution efforts to mitigate operational and financial risk.
- Collaborated with internal stakeholders to address and resolve complex claim issues, improving overall claims handling.
Customer Service Representative
Health Care Service Corporation (HCSC)
02.2019 - 05.2020
- Supported members and providers with benefits, eligibility, claims, and coverage inquiries, enhancing understanding and satisfaction.
- Researched and resolved inquiries while upholding service standards, contributing to overall customer satisfaction.
- Ensured compliance with privacy, confidentiality, and healthcare regulations, safeguarding sensitive information.
Education
Bachelor of Science - Business, Project Management
University of Phoenix
Phoenix, AZ 01.2024 - 07.2026
Skills
- Healthcare Operations
- Compliance support
- Quality assurance
- Risk management
- Contract analysis
- Policy Analysis
- Business Process Improvement
- Process Reengineering
- Project management
- Root Cause Analysis
- Change Management
- Cross-functional teamwork
- Stakeholder management
- Strategic Problem Solving
ADDITIONAL QUALIFICATIONS
- Compliance, Governance & Project Experience
- Experience reviewing contracts and operational workflows to ensure alignment with business requirements and organizational objectives.
- Experience conducting operational audits, quality reviews, and compliance assessments.
- Experience developing governance documents, procedural guidance, and implementation communications.
- Experience coordinating enterprise initiatives involving operations, leadership, business stakeholders, and technical teams.
- Experience building and maintaining knowledge management resources to support organizational effectiveness.
- Strong organizational, analytical, and written communication skills with the ability to communicate complex information to diverse audiences.
- Proven ability to manage multiple priorities while working independently in a fast-paced healthcare environment.
Resume Headline for Internal Application
- Compliance, Governance & Project Experience
- Experience reviewing contracts and operational workflows to ensure alignment with business requirements and organizational objectives.
- Experience conducting operational audits, quality reviews, and compliance assessments.
- Experience developing governance documents, procedural guidance, and implementation communications.
- Experience coordinating enterprise initiatives involving operations, leadership, business stakeholders, and technical teams.
- Experience building and maintaining knowledge management resources to support organizational effectiveness.
- Strong organizational, analytical, and written communication skills with the ability to communicate complex information to diverse audiences.
- Proven ability to manage multiple priorities while working independently in a fast-paced healthcare environment.
Timeline
Bachelor of Science - Business, Project Management
University of Phoenix
01.2024 - 07.2026
Coordinator
Health Care Service Corporation (HCSC)
04.2023 - Current
Customer Advocate Specialist
Health Care Service Corporation (HCSC)
08.2022 - 04.2023
Customer Service Representative II
Health Care Service Corporation (HCSC)
02.2021 - 08.2022
Claims Analyst
Health Care Service Corporation (HCSC)
05.2020 - 02.2021
Customer Service Representative
Health Care Service Corporation (HCSC)
02.2019 - 05.2020