Latavia Fletcher-Williams
Miami Gardens
Summary
Dynamic Capability Analyst with United Health Group, adept at driving process improvements and enhancing operational efficiency. Leveraging strong analytical skills and effective communication, I recovered $1 million in erroneous claims while implementing strategies that reduced escalated member issues by 15%. Committed to delivering exceptional results in compliance and claims management. Strategic professional in business operations known for high productivity and efficiency in task completion. Specialize in process optimization, project management, and data analysis, ensuring streamlined workflows and enhanced operational efficacy. Excel in communication, problem-solving, and leadership, leveraging these soft skills to drive team success and achieve organizational goals.
Overview
21
21
years of professional experience
Work History
Capability Analyst
United Health Group
Minneapolis
03.2022 - Current
- Diagnose and implement process improvement strategies, leading to a 15% reduction in escalated member issues through application of process excellence techniques
- Collaborate effectively with cross-functional teams to prevent member issues, enhancing claim resolution efficiency by 20% through improved test scenarios
- Investigate claims rigorously, recovering $1 million in erroneous payouts through robust claims processing and documentation management
- Identify and address aberrant billing patterns, initiating fraud prevention strategies that flagged 5 high-risk providers, saving significant costs in fraudulent claims
SIU Pre-Pay Investigator
Optum
Eden Prairie
06.2020 - 03.2022
- Examined and assessed business operations and procedures, resulting in a 20% improvement in process optimization ensuring data integrity and security
- Investigated, recovered, and resolved various claims, achieving a 15% increase in recovery rates from health plans, commercial customers, and government entities
- Initiated communication with members, providers, and insurance companies, successfully coordinating benefits information and enhancing reimbursement accuracy
- Ensured adherence to state and federal compliance policies and contract compliance, streamlining subrogation claims management through the use of software tools such as Microsoft Office, SharePoint, and PEGA
Appeals Representative
United Health Group
Doral
08.2015 - 06.2020
- Determined and confirmed member eligibility and benefits, ensuring accuracy and compliance with federal and state regulations
- Resolved 95% of written complaints effectively within required timeframes, enhancing customer satisfaction and relations
- Conducted thorough research and analysis using tools such as CPW, COSMOS, Webstrat, and CareOne to process appeals, yielding a 20% improvement in workflow efficiency
- Led meetings and coordinated project management activities to streamline appeal processing, fostering an environment of problem-solving and continuous process improvement
Claims Representative Associate
United Health Group
Doral
01.2014 - 08.2015
- Reviewed and processed claims with a focus on accuracy and compliance, utilizing tools such as BPQM, CPW, and COSMOS to streamline operations
- Investigated claims using data analytical skills, ensuring a high degree of precision and validity, leading to a 15% reduction in processing errors
- Negotiated and authorized claims payments, consistently achieving productivity targets and adhering to a schedule that improved workflow management efficiency by 20%
- Collaborated with team members and utilized SharePoint and Microsoft Office to ensure seamless documentation and knowledge sharing, enhancing organizational skills across departments
Sales Associate/Team Lead
AT&T
Miami
03.2004 - 01.2014
- Consulted with customers to recommend telecommunications products and services tailored to their needs, resulting in a 15% increase in customer satisfaction scores
- Utilized CRM systems effectively to manage customer relations, achieving a sales quota performance of 120% consistently for three consecutive quarters
- Facilitated cross-functional business meetings to streamline processes, enhancing workflow efficiency and reducing processing time by 20%
- Led the team in escalation calls and resolution, thereby ensuring customer care commitments were met and improving team response times to inquiries by 25%
Education
Bachelors - Criminal Justice Management
Union Institute & University
North Miami Beach, USA04.2010
Associates - Criminal Justice Administration
Miami Dade Community College
Miami, USA04.2004
Diploma - General Studies
Miami Northwestern Senior High School
Miami, USA05.1992
Skills
- Analytical Skills
- BPQM
- CareOne
- Claims Investigation
- Claims Processing
- Communication
- Compliance Policies
- Contract Compliance
- COSMOS
- CPW
- CRM
- Customer Relations Management
- Customer Service
- Data Integrity
- Data Security
- Delegation
- Detects
- DOC 360
- DOCDNA
- Documentation Management
- ECAA
- E&I Smart Tool
- Emptoris
- HSR
- IBAAG
- ISET
- Letter Now
- Meeting Facilitation
- Microsoft Office
- MS Office (Outlook, Word, Excel, Power Point)
- Navigator
- NDB
- Organizational Skills
- PEGA
- PICTS
- PIQ
- Problem Solving
- Process Excellence
- Process Improvement
- Project Management
- Recovery and Resolution
- Reimbursement Policies
- Rightfax
- Sales
- Sharepoint
- State and Federal Compliance
- Subrogation Claims
- Telecommunications
- Time Management
- Wand
- Webstrat
- Workflow Management
Timeline
Capability Analyst
United Health Group
03.2022 - Current
SIU Pre-Pay Investigator
Optum
06.2020 - 03.2022
Appeals Representative
United Health Group
08.2015 - 06.2020
Claims Representative Associate
United Health Group
01.2014 - 08.2015
Sales Associate/Team Lead
AT&T
03.2004 - 01.2014
Bachelors - Criminal Justice Management
Union Institute & University
Associates - Criminal Justice Administration
Miami Dade Community College
Diploma - General Studies
Miami Northwestern Senior High School
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