Maisha Williams
Plainfield,NJ
Summary
Customer Service Professional with 10+ years of experience resolving complex member issues, processing claims, and delivering compassionate, top-tier support in high-volume call center and healthcare environments. Skilled in de-escalating sensitive situations, investigating claims and benefits, and coordinating across departments to ensure timely and accurate resolutions. Adept at trend analysis, root cause investigation, and compliance with HIPAA/privacy standards. Recognized for strong communication, problem-solving, and member-first approach that drives satisfaction, loyalty, and operational excellence. Seeking to leverage deep knowledge of claims, enrollment, and appeals to deliver outstanding member experiences
Overview
14
14
years of professional experience
Work History
Claims Processor
United Health Group, Optum
01.2021 - 09.2025
- Receive escalated member inquiries via phone, fax, mail, e-mail, online, social media, etc. Probe for additional helpful information (i.e. member ID, claim number, name, etc.) in order to effectively handle inquiry.
- Processed insurance claims efficiently, ensuring compliance with company policies and industry regulations.
- Reviewed claim documentation for accuracy, identifying discrepancies and facilitating timely resolutions.
- Responded to over customer calls swiftly to resolve issues and answer questions.
- Managed high-volume inbound and outbound calls to address customer inquiries and resolve issues ranging from 50-100 calls a day.
Pharmacy Technician
Pharm Script
02.2017 - 11.2020
- Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
- Calculated dosage, filled prescriptions, and prepared prescription labels with absolute accuracy.
- Solved customer problems in-person or over telephone by providing assistance with placing orders, navigating systems, and locating items.
- Answered over 100 calls a Day
- Entered and processed patients' prescriptions into internal system.
Patient Financial Services Representative
Well Star Cobb Hospital
Austell, Georgia
01.2012 - 12.2016
- Negotiated payment arrangements with self-pay patients, offering flexible solutions that aligned with their financial capabilities.
- Improved patient satisfaction by providing timely and accurate financial information.
- Reduced errors in billing, conducting thorough audits of patient accounts and identifying discrepancies.
- Increased patient understanding of financial obligations, providing detailed explanations of charges and available payment options
- Managed approximately 50-100 incoming calls, emails and faxes per day from customers.
Education
High School Diploma -
West Side High School, Newark, Nj,07106
Newark, NJ06.2011
Skills
- Strong oral and written communication skills
- Great ood PC skills and the ability to utilize Microsoft Office applications (Excel, Access, Word, etc)
- Excellent customer service skills including the ability to manage and diffuse irate calls
- Ability to work in a high pressure, fast-paced environment
- Ability to multitask
- Ability to work effectively within a team environment
- Great presentation skills
Timeline
Claims Processor
United Health Group, Optum
01.2021 - 09.2025
Pharmacy Technician
Pharm Script
02.2017 - 11.2020
Patient Financial Services Representative
Well Star Cobb Hospital
01.2012 - 12.2016
High School Diploma -
West Side High School, Newark, Nj,07106
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