Tamara Williams
Columbia,SC
Summary
Results-driven healthcare professional with 15+ years of experience in claims analysis, adjudication, and healthcare operations. Expertise in complex claims resolution, quality audits, and process improvements, ensuring compliance with industry regulations while enhancing operational efficiency. Adept at training, cross-functional collaboration, and customer issue resolution. Proven ability to drive process enhancements and improve claims accuracy, contributing to increased customer satisfaction and reduced errors.
Overview
17
17
years of professional experience
Work History
Senior Quality Assurance Analyst
Blue Cross Blue Shield
07.2025 - Current
- - Serve as subject matter expert for the Medicaid Lock-In Program, ensuring compliance with state and federal regulations.
- - Manage member enrollment and disenrollment through the State Portal and internal systems (e.g., PHS), maintaining accurate program data.
- - Conduct audits, data reviews, and quality checks to reduce fraud, waste, and abuse within the Medicaid population.
- - Collaborate with cross-functional teams including Pharmacy, Medical Management, and Compliance to drive program success.
- - Produce trend analyses, support reporting efforts, and make data-informed recommendations for process improvements.
- - Develop SOPs and training documentation while mentoring staff on Lock-In Program procedures.
Pharmacy Program Coordinator
Blue Cross Blue Shield
04.2023 - 07.2025
- - Manage claims-related discrepancies, ensuring timely resolution of overrides, prior authorizations, and pharmacy assignments to optimize member experience.
- - Collaborate with cross-functional teams to streamline issue resolution and improve response times for member inquiries.
- - Conduct market research and recommend process improvements, contributing to operational efficiency and enhanced claims accuracy.
Customer Service Representative
Cigna
11.2022 - 04.2023
- - Handled high-volume customer inquiries, resolving claims and benefit-related issues with professionalism and accuracy.
- - Provided in-depth guidance on disease management and healthcare programs, improving member engagement.
- - Demonstrated strong problem-solving skills, achieving high first-call resolution rates.
Inside Sales Representative
Spectrum
07.2022 - 10.2022
- - Maintained high levels of customer satisfaction through effective sales strategies and personalized service.
- - Exceeded sales targets by identifying upsell and cross-sell opportunities.
- - Developed consultative sales techniques to enhance customer retention and drive revenue growth.
Marketing Project Specialist
Blue Cross Blue Shield
02.2020 - 07.2022
- - Led marketing initiatives for new and existing healthcare products, ensuring successful implementation and compliance with industry standards.
- - Managed post-launch product evaluations, leveraging customer insights to refine and enhance service offerings.
- - Conducted data-driven analysis of customer feedback, optimizing processes and improving overall service delivery.
Training Specialist II
Blue Cross Blue Shield
10.2017 - 02.2020
- - Designed and delivered comprehensive training programs on pharmacy processes and claims adjudication, boosting team efficiency and accuracy.
- - Developed training materials, work instructions, and SOPs, ensuring consistent understanding and execution of claims processing.
- - Conducted classroom and one-on-one training, enhancing team capabilities and reducing processing errors.
Sr. Quality Assurance Analyst
Blue Cross Blue Shield
09.2014 - 10.2017
- - Conducted detailed quality audits across claims processing and pharmacy operations, ensuring adherence to company and regulatory standards.
- - Developed desk procedures and instructional materials to enhance staff proficiency and support performance improvement.
- - Led training initiatives for pharmacy support teams, instrumental in the successful rollout of a Specialty Pharmacy PBM initiative.
Claims Analyst II
Blue Cross Blue Shield
06.2008 - 09.2014
- - Processed medical claims for commercial and government health plans.
- - Investigated claim discrepancies and coordinated with external partners to resolve rejections.
- - Identified trends in denials and developed solutions to minimize recurring issues.
- - Provided support and training to new team members on claims systems and compliance standards.
- - Analyzed, processed, and updated Medicare and Coordination of Benefits (COB) data, ensuring accuracy in customer records.
- - Investigated and resolved complex claims issues, executing adjustments and reprocessing claims to uphold compliance and service standards.
- - Collaborated with internal teams to enhance claims adjudication processes, reducing errors and improving efficiency.
Education
Bachelor of Arts (B.A.) - African American Studies
University of South Carolina
Columbia, SCMaster of Arts - Human Resources Management
Webster University
St. Louis, MOSkills
- - Claims Analysis & Adjudication
- - Complex Claims Resolution
- - Quality Audits & Compliance
- - Process Improvement & Efficiency
- -COB Adjustments
- - Cross-Functional Collaboration
- - Training & Staff Development
- - Customer & Member Engagement
- - Data Analysis & Reporting
- Commercial, Medicare, and Medicaid
Timeline
Senior Quality Assurance Analyst
Blue Cross Blue Shield
07.2025 - Current
Pharmacy Program Coordinator
Blue Cross Blue Shield
04.2023 - 07.2025
Customer Service Representative
Cigna
11.2022 - 04.2023
Inside Sales Representative
Spectrum
07.2022 - 10.2022
Marketing Project Specialist
Blue Cross Blue Shield
02.2020 - 07.2022
Training Specialist II
Blue Cross Blue Shield
10.2017 - 02.2020
Sr. Quality Assurance Analyst
Blue Cross Blue Shield
09.2014 - 10.2017
Claims Analyst II
Blue Cross Blue Shield
06.2008 - 09.2014
Bachelor of Arts (B.A.) - African American Studies
University of South Carolina
Master of Arts - Human Resources Management
Webster University
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