Overview
Work History
Education
Skills
Certification
Timeline
Generic

Predella Wilson

Jacksonville,FL

Overview

13
13
years of professional experience
1
1
Certification

Work History

TPA ADMINISTRATOR (CONTRACT )

Spherion
05.2024 - Current
  • Enrolled consumers in group health insurance after separation from their employer.
  • Monitored changes in healthcare laws and regulations to ensure compliance with current guidelines.
  • Researched complex issues related to plan design, eligibility, enrollment, and claim adjudication process.
  • Implemented new procedures for administering COBRA benefits in accordance with applicable laws.
  • Analyzed financial statements to identify if policies need to be terminated or reinstated.
  • Answered phone calls and emails from clients to address questions, complaints, and needs.

CUSTOMER CARE REPRESENTATIVE

Citizens Property Insurance
08.2020 - 04.2024
  • Demonstrated strong communication skills to interact with customers via phone, email and online chat. Provided excellent customer service, resolving inquiries and complaints in a timely manner.
  • Managed workload effectively by prioritizing tasks according to urgency or importance.
  • Maintain knowledge of insurance rates, insurance rules as well as procedures.
  • Provided guidance on claims processing procedures for clients seeking reimbursement.
  • Provided support during audits conducted by external organizations or regulatory bodies.
  • Identified potential risks associated with clients' property, assets, and liabilities. Conducted research to identify new markets for insurance products.
  • Prepared quotes and proposals based on clients' requirements and needs.

ADVOCATE IV - SERVICE ADVOCATE

Florida Blue
11.2012 - 08.2020
  • Provide a customer friendly service experience for customers with questions or issues related to health care, health insurance (benefits, claims, premium payments, membership, billing, and enrollment) or other related topics.
  • Handle all inquiries related to the following: the Federal Market Place, CMS, ACA Compliance rules, individual enrollment, billing, reconciliation.
  • Assist members / groups with Cobra regulations and guidelines.
  • Served as a “Universal” Service Advocate responding to inquires related to all segments including Medicare, Group, and Consumer (U65) across multiple functions (EM&B and Customer service)
  • Partner with agents and the Agent Service Center and participate in identification of root cause resolution for any outstanding issues
  • Resolve critical inquiries and ensure quality management of processes is in place.
  • Managed team projects by assigning tasks, setting deadlines and tracking progress.
  • Trained new employees on call center procedures, policies, and best practices.
  • Maintained up-to-date knowledge of healthcare products and services available at the facility in order to provide accurate answers to caller inquiries.
  • Utilized various software programs

Debt Collector

GC Services
07.2012 - 10.2013
  • Collected on delinquent accounts to reduce overdue balances.
  • Resolved customer disputes and disagreements through professional, calm communication to find mutually beneficial solutions.
  • Educated debtors about student loan repayment options, enabling them to make informed decisions while preserving positive business relationships.
  • Developed strong relationships with customers to foster timely payments and account resolution.
  • Negotiates arrangements with customer to bring accounts current.
  • Skip Tracing as required to locate customer contact information.
  • Prepares and submit Change in Terms processing.

FRAUD ANALYST

Incomm
02.2012 - 07.2013
  • Assist customers with handling gift card activation & utilization.
  • Evaluated customer data to identify and prevent fraudulent activities.
  • Performed risk assessments to determine level of fraud risk and prioritize investigations.
  • Tracked fraud cases and monitored trends to develop strategies for prevention.
  • Conducted thorough investigations on suspicious cases, ensuring timely resolution and minimizing financial impact.
  • Maintained up-to-date knowledge of regulations related to fraud prevention, ensuring compliance with relevant laws and guidelines.

Education

HIGH SCHOOL DIPLOMA -

FLORIDA STATE COLLEGE
07.2011

Skills

  • System Documentation
  • Payment Processing
  • Technical Troubleshooting
  • HIPAA Guidelines
  • Type 45 WPM
  • Microsoft Excel
  • Microsoft Word
  • Microsoft PowerPoint
  • Call Center Operations
  • Computer Proficiency
  • Customer Retention Strategies
  • Time Management
  • Analytical thinking
  • Cobra Administration
  • Multi System Navigation
  • Leadership Skills
  • Workflow option
  • Fraud Detection
  • Fraud prevention
  • Telephone and email etiquette
  • Financial Modeling
  • Dispute Resolution
  • Financial Analysis
  • Anti-Fraud Systems
  • Interpersonal Skills
  • Skip Tracing
  • Remote Call Center

Certification

  • 100% Quality
  • APT Certified
  • Ulysses
  • CPR
  • BLS
  • HIPPA

Timeline

TPA ADMINISTRATOR (CONTRACT )

Spherion
05.2024 - Current

CUSTOMER CARE REPRESENTATIVE

Citizens Property Insurance
08.2020 - 04.2024

ADVOCATE IV - SERVICE ADVOCATE

Florida Blue
11.2012 - 08.2020

Debt Collector

GC Services
07.2012 - 10.2013

FRAUD ANALYST

Incomm
02.2012 - 07.2013

HIGH SCHOOL DIPLOMA -

FLORIDA STATE COLLEGE
  • 100% Quality
  • APT Certified
  • Ulysses
  • CPR
  • BLS
  • HIPPA

Similar Profiles

CREATE PROFILE
Predella Wilson