Mikael Spencer

• Responsible for reviewing, analyzing, and processing policies associated to claim events to establish what the company's liability and entitlement will be.
• Completed in-depth investigations into issues pertaining to discipline and grievance management and recommended strategies.
• In depth knowledge of CMS regulations and specific state Medicaid regulations.
• Root cause analysis using CPT/Diagnosis code combinations and claim submission trends.
• Developed strong working relationships with internal and external stakeholders, fostering a collaborative environment for efficient resolution of appeals.
• Organized and managed appeals caseloads, prioritizing high-priority cases for timely resolution.
• Conducted detailed audits on case files, ensuring accuracy and completeness of information for better decision making.
  Coordinated with medical professionals and subject matter experts for case reviews, obtaining necessary clarification for accurate decision making.
• Maintained comprehensive knowledge of regulatory guidelines to ensure compliance within the appeals department.
• Enhanced case resolution efficiency by conducting thorough investigations and analyzing evidence.
• Supported legal proceedings by providing accurate and detailed reports on investigation findings.
• Optimized resource allocation in high-priority cases, ensuring timely delivery of critical information to stakeholders.

• Preschool teacher providing educational and therapeutic spiritual teachings-based services for very young children with developmental disabilities.
• Established positive relationships with students and families
• Implemented behavior modification strategies, resulting in improved self-regulation and classroom participation among students
• Organized activities to teach preschool children foundational learning skills such as letters and numbers
• Managed classroom resources efficiently to ensure all materials were readily available for planned activities throughout the day

• Early Childhood Educator responsible for supervising children and guiding their development of foundation to succeed in elementary school.
• Designed innovative initiatives to engage parents in educational process for student benefit
• Established and maintained consistent classroom rules and expectations for obedience
• Created and supervised variety of hands-on learning activities for fun and engagement
• Evaluated student progress regularly through formative assessments to inform instructional decisions
• Observed and assessed student performance and charted progress

• Customer focus, effective communication, great interpersonal skills, stamina, problem-solving orientation, and knowledge of customer escalation.
• Conducted regular quality assurance checks on interactions with customers to ensure agents were meeting established guidelines and standards for service excellence
• Developed rapport with customers through active listening skills, leading to higher retention rates and positive feedback from clients
• Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike

• Plans, conducts, organizes and supervise recreational programs to include individual and team activities, indoor and outdoor games, and special adaptive recreational programs.
• Planned weekly activities schedule for assigned group and facilitated smooth transitions for on-time arrival
• Supervised camper activities to address behavioral issues and promote fun, safety and inclusivity
• Cared for personal and health needs of disabled campers

Master of Social Work (MSW)

Concentrations in

• Sociology
• African American Studies