Summary
Overview
Work History
Education
Skills
Timeline
Generic

TAWANNA WILLIAMS

Stone Mountain,GA

Summary

Detail-oriented Examiner with several years of experience. Strong command of conflict resolution and negotiation combined with excellent reporting and research skills. Thorough understanding of claims process and benefits examinations.

Overview

9
9
years of professional experience

Work History

Benefits Claims Examiner

Social Security Administration
09.2023 - Current
  • Review initial claims and applications.
  • Review medical treatment records and reports for accuracy and determination.
  • Evaluates statements, claims and evidence for sufficiency consistency, validity and credibility.
  • Interview or correspond with claimants, witnesses, physicians, or other relevant parties to determine claim settlement, denial, or review.
  • Defines the scope of information pertinent to and supporting the application for benefits and develops a strategy to obtain that information
  • Develop and adjudicate decisions for initial claims for Social Security and or Supplemental Security Income disability benefits under federal and state laws, regulations, policies and procedures
  • Determine eligibility for disability benefits by preparing a formal determination including the completion of forms and an explanation of the determination
  • Mitigate fraud risks by identifying suspicious patterns in claims data and escalating concerns to appropriate teams for further investigation.
  • Determines the type of documents necessary to support a decision.
  • Contact doctors, psychologists and other healthcare professionals to obtain information to substantiate a claim.
  • Achieve streamlined communication between departments by collaborating closely with underwriters, agents, and other stakeholders throughout the claims-handling process.
  • Present cases and participate in their discussion at claim committee meetings.
  • Finalize files for insurance claim payment release.
  • Prepare and release correspondence for other federal, state, and local agencies.
  • Prepare and release final correspondence for claimant upon completion of benefits processing.

Patient Care Coordinator

Emory Saint Joseph's Hospital
08.2022 - 11.2022
  • Registered new patients and scheduled appointments for new and established patients
  • Worked with management to resolve patient issues, while making every effort to escalate patient complaints when necessary.
  • Monitored patient health records for accuracy to meet compliance with healthcare guidelines.
  • Trained new staff members on office procedures and protocols, ensuring consistency in patient care delivery.
  • Adeptly managed a multi-line phone system and pleasantly greeted all patients
  • Acted as main point of contact for patients, doctors, and hospital staff by closely reviewing medical charts and maintaining high levels of communication.
  • Fostered strong relationships with referral sources for increased network connections, benefiting both the clinic and its patients through expanded resources.
  • Provided compassionate support for families during difficult healthcare decisions, acting as a liaison between them and their loved ones'' medical team.

Call Center Associate

Emory Healthcare
10.2021 - 05.2022
  • Identified insurance payment sources and listed payers in the proper sequence to establish the chain of payment
  • Answered inbound calls in a high-volume call center environment
  • Accurately entered all patient demographic, medical, and financial information into the center Millennium scheduling software
  • Responsible for scheduling, rescheduling, and canceling all outpatient procedures
  • Remained current with outpatient procedural knowledge, while providing clinical prep instructions to callers as needed.
  • Provided excellent customer care by responding to requests, assisting with product selection and handling ordering functions.
  • Received multiple positive reviews acknowledging dedication to excellent customer service.

Administrative Assistant

Georgia Dept Of Family & Children Services
08.2019 - 03.2020
  • Screened and registered applicants for eligible programs offered
  • Accessed client files on an as needed basis and ensured the security and confidentiality of client files and information
  • Assisted clients with information via phone, email, and in person
  • Prepared source data for computer entry by compiling and sorting information garnered from handwritten documents, phone calls, and computer system recordings
  • Provided general administrative and clerical support including mailing, filing, typing, copying, faxing, and scanning
  • Processed applications using appropriate criteria and policies consistently and according to established guidelines to determine eligibility for Family Medicaid and SNAP benefits.

Payroll Clerk (Temporary)

Dekalb County Schools
02.2019 - 07.2019
  • Initiated direct deposits and prepared manual checks for employees
  • Maintained payroll information by collating, calculating, and entering data
  • Verified employees' work hours and payment through the payroll system, while also issuing deductions, earnings, and other statements to employees
  • Communicated with various departments to process pay information and handled questions from supervisors and employees regarding paychecks, timecards, and other payroll-related issues
  • Improved employee satisfaction by successfully training other employees in correct payroll handling
  • Administered wage garnishments and child support deductions
  • Updated employee files with new details such as changes in address, family, or salary levels.

Customer Service Representative

DeKalb County School District Transportation
07.2018 - 02.2019
  • Answered customer telephone calls in a prompt fashion to avoid on-hold wait times
  • Assisted customers with appointment setting, special order requests, and arranging merchandise pickup
  • Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns while paying attention to any special needs or wants
  • Kept records of all customer interactions by maintaining and filing records
  • Resolved transportation issues by clarifying transportation rules, regulations, and policies; determining the cause of the problem; selecting explaining the best solution to resolve the issue; expediting correction or adjustment; and following up to ensure resolution.

Healthcare Call Center Specialist

Humana
03.2015 - 02.2018
  • Achieved a consistently high satisfaction rating through proactive one-call resolutions of customer issues
  • Provided excellent customer care by responding to requests, assisting with product selection, handling ordering functions, and promoting available products and services to customers
  • Maintained up-to-date knowledge of all changes to products and services
  • Accessed caller accounts to determine benefits, identify service needs, and resolve issues
  • Maintained accurate and current customer account data with manual forms processing and digital information updates
  • Delivered prompt service to prioritize customer needs.

Education

HIGH SCHOOL DIPLOMA -

GEORGIA PIEDMONT TECHNICAL COLLEGE
PIEDMONT, GEORGIA
08.2007

Skills

  • Team collaboration
  • Self-Motivated
  • Healthcare Common Procedures Coding System (HCPCS)
  • Accredited Claims Adjuster
  • Investigation Management
  • Medical Scheduling
  • Risk Management
  • Regulatory Compliance
  • File and Record Management
  • Time Management
  • Proficient in verbal and written communication
  • Strong Attention to Detail
  • Insurance verification
  • Team Leadership

Timeline

Benefits Claims Examiner

Social Security Administration
09.2023 - Current

Patient Care Coordinator

Emory Saint Joseph's Hospital
08.2022 - 11.2022

Call Center Associate

Emory Healthcare
10.2021 - 05.2022

Administrative Assistant

Georgia Dept Of Family & Children Services
08.2019 - 03.2020

Payroll Clerk (Temporary)

Dekalb County Schools
02.2019 - 07.2019

Customer Service Representative

DeKalb County School District Transportation
07.2018 - 02.2019

Healthcare Call Center Specialist

Humana
03.2015 - 02.2018

HIGH SCHOOL DIPLOMA -

GEORGIA PIEDMONT TECHNICAL COLLEGE

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TAWANNA WILLIAMS