Margrett Jones
Little Elm,TX
Summary
Results-oriented Analyst skillful in managing and breaking down large volumes of information. Proactive at heading off issues in operations, workflow, and production by uncovering trends affecting business success. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
15
15
years of professional experience
Work History
Escalation Analyst Lead
US Anesthesia Partners Of Texas
05.2019 - Current
- Increased efficiency by streamlining data analysis processes and implementing automation tools.
- Identified trends and patterns in large datasets, leading to actionable insights for business growth.
- Developed new analytical models that improved forecasting accuracy and reduced risk exposure.
- Enhanced team collaboration by clearly communicating complex findings through visualizations and reports.
- Resolved customer complaints by effectively managing escalations and addressing concerns promptly.
- Improved customer satisfaction ratings by providing prompt, empathetic support to clients facing issues.
- Maintained comprehensive records of all escalated cases, tracking trends and identifying areas for improvement.
- Streamlined escalation process by developing clear communication guidelines for team members and stakeholders.
- Monitored and analyzed customer feedback to track feedback patterns and report improvement areas to management.
Grievance Appeals Specialist
Molina Healthcare
09.2018 - 05.2019
- Enhanced grievance appeals efficiency by streamlining processes and implementing best practices.
- Reduced case backlog significantly through diligent review and resolution of pending grievances.
- Improved customer satisfaction rates by providing timely and empathetic responses to appeals inquiries.
- Conducted thorough investigations for complex cases, ensuring fair and accurate outcomes.
- Maintained compliance with regulatory requirements by staying current on industry standards and guidelines.
- Resolved escalated cases promptly and effectively, demonstrating strong negotiation skills when liaising with stakeholders.
- Communicated effectively with staff members of operations, finance and clinical departments.
- Communicated verification and authorization status updates with department to facilitate decision-making for patient admissions and insurance coverage.
- Notified insurance agents and accounting departments of policy cancellations and changes.
- Developed comprehensive reports analyzing trends in grievance appeals, resulting in targeted improvements to policies and procedures.
- Assisted in policy development by providing expert insights based on experience handling complex grievances and appeals cases.
Grievance Appeals Specialist
Centene Corporation
01.2016 - 09.2017
- Conducted thorough investigations for complex cases, ensuring fair and accurate outcomes.
- Collaborated with cross-functional teams to address systemic issues identified during the grievance appeals process.
- Implemented quality control measures that ensured accuracy in case documentation and reduced instances of rework or errors in processing claims.
- Optimized workflows within the department by identifying inefficiencies and making recommendations for improvement based on data-driven analysis.
- Displayed excellent time management skills while managing multiple high-priority cases concurrently without compromising quality or attention to detail.
- Organized regular meetings for the Grievance Appeals team to discuss updates, share knowledge, and address challenges collectively.
- Leveraged advanced analytical abilities when evaluating the evidence presented in appeal cases, rendering unbiased judgments aligned with organizational policies.
- Demonstrated exceptional problem-solving skills when faced with unique or challenging cases, resulting in successful resolutions that satisfied all parties involved.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
Customer Service Representative Lead
Comcast Cable Company
12.2008 - 11.2014
- Enhanced customer satisfaction by promptly addressing concerns and providing accurate information.
- Streamlined call center processes for improved efficiency and reduced wait times.
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Assisted customers in navigating company website and placing online orders, improving overall user experience.
- Maintained detailed records of customer interactions, ensuring proper follow-up and resolution of issues.
- Managed escalated calls effectively, minimizing negative impact on client relations while maintaining composure under pressure.
- Maintained detailed records of all interactions with clients, ensuring accurate data collection for future reference.
- Resolved escalated customer service inquiries and complaints to maintain satisfaction.
- Promoted superior experience by addressing customer concerns, demonstrating empathy, and resolving problems swiftly.
Education
High School Diploma -
Forest Hill High School
Jackson, MS05.2003
Skills
- Root Cause Analysis
- System Analysis
- Risk Mitigation
- Audit Support
- Issue Identification
- Trend Analysis
- MS Excel
- Analytical Thinking
- Team Collaboration and Leadership
- Data Research and Validation
- Strategic Planning
- Problem Solving
- Critical Thinking
- Risk Assessment
- Data Analysis
Timeline
Escalation Analyst Lead
US Anesthesia Partners Of Texas
05.2019 - Current
Grievance Appeals Specialist
Molina Healthcare
09.2018 - 05.2019
Grievance Appeals Specialist
Centene Corporation
01.2016 - 09.2017
Customer Service Representative Lead
Comcast Cable Company
12.2008 - 11.2014
High School Diploma -
Forest Hill High School
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