TAMAZIA C. L. SIMON
Florence,SC
Summary
Dynamic professional with a proven track record at Blue Cross Blue Shield, excelling in problem-solving and strong communication. Successfully managed complex claims processes and implemented quality management principles, enhancing program efficiency. Adept in project management and fostering teamwork, consistently achieving high performance standards in challenging environments.
Overview
7
7
years of professional experience
Work History
Customer Service Advocate II
Blue Cross Blue Shield
Columbia, South Carolina
02.2024 - 03.2025
- Handling appeals for denied claims by reviewing cases, gathering necessary documentation, and communicating with relevant parties to resolve issues
- Assisting providers in obtaining prior authorization for medical services or procedures by coordinating with healthcare providers and insurance companies to ensure compliance with policy requirements
- Managing and processing claims for medical services, addressing any discrepancies or issues, and ensuring timely resolution to facilitate payment for services rendered
- Providing support and information related to Medicare Part A (hospital insurance), and Home Health Hospice services
PROGRAM DIRECTOR
Life Links, LLC
01.2022 - 02.2024
- Implement and manage programs that meet the needs of beneficiaries that are enrolled in the program
- Develop evaluation systems
- Manage program logistics
- Ensure proper function of program
- Apply quality management principles and processes
- Analyze program risk.
YOUTH LEADER
Life Links LLC
01.2018 - 01.2022
- Assist program participants with setting long and short term goals
- Ensured program participants met with their advisor to complete treatment planning
- Facilitated weekly group discussions with program participants around trending youth topics.
- Assisted program participants with gaining access to educational resources to assist with closing achievement gaps
Education
BACHELOR OF SCIENCE - Family and Consumer Services
01.2023
Skills
- Leadership Capacity
- Problem-Solving
- Computer Literacy
- Project Management Tools
- Strong Communication
- Program planning
- Teamwork and collaboration
- Performance standards and analysis
References
Dr. Tamiquia T. Wilson, 843.616.4225
Languages
English
Timeline
Customer Service Advocate II
Blue Cross Blue Shield
02.2024 - 03.2025
PROGRAM DIRECTOR
Life Links, LLC
01.2022 - 02.2024
YOUTH LEADER
Life Links LLC
01.2018 - 01.2022
BACHELOR OF SCIENCE - Family and Consumer Services
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