Tamika Walker
Raymore,MO
Summary
Highly skilled and results-driven professional with extensive experience in the healthcare industry, specializing in case management, authorizations, and health insurance. Proven track record of efficiently processing patient information, managing claims, and maintaining detailed case files. Strong background in reviewing claims data to identify and resolve issues, contributing to streamlined operations, and improved patient outcomes. Adept at collaborating with cross-functional teams to develop and implement individualized care plans, ensuring quality and compliance in all aspects of case management and healthcare. A dedicated team player, with a focus on improving processes and delivering exceptional service in fast-paced healthcare environments.
Overview
17
17
years of professional experience
Work History
Customer Service Representative
Evry Health
Dallas, TX
06.2025 - Current
- Delivered exceptional customer service through proficient phone and email interactions.
- Utilized company systems and resources to resolve customer inquiries efficiently.
- Communicated claim status updates to both providers and members.
- Confirmed eligibility and benefits for provider offices.
- Resolved member and provider inquiries via email correspondence.
- Delivered prior authorization status for provider.
- Inbound/Outbound calls.
Case Manager Processor
Molina Health Care
05.2023 - Current
- Enter patient information into case management systems, ensuring accurate and up-to-date data.
- Review initial case details to identify potential needs and assist in the development of comprehensive care plans.
- Maintain and update case files and documentation in the case management system, ensuring compliance with regulations and standards.
- Ensured all patient case files were meticulously maintained, contributing to a smooth case management process and compliance with internal standards.
- Improved patient information entry efficiency by 25%, significantly reducing processing time for new cases.
- Monitored and updated case management systems regularly, helping ensure that patient information was always current and accessible.
Customer Service Rep
L.A. Care Health Plan
Los Angeles, USA
09.2022 - 05.2023
- Resolved grievances and appeals for members, ensuring swift and efficient handling to provide effective solutions.
- Provided timely and clear updates to members regarding the status of their claims, offering detailed and consistent communication.
- Scheduled appointments for MediCal members, coordinating with healthcare providers to ensure access to appropriate care.
- Los Angeles, CA
- Consistently improved member satisfaction by offering personalized support and promptly addressing their concerns.
- Streamlined the claims update process, reducing the time needed for members to receive status updates by 25%.
- Developed strong rapport with members, becoming a trusted point of contact for their inquiries and claims.
- Efficiently handled high call volumes while maintaining a high standard of service and positive feedback from members.
Patient Quality Specialist
Apria Healthcare
Overland Park, USA
01.2018 - 08.2022
- Verified eligibility and coverage for various insurance plans, including Medicare and Medicaid, ensuring complete and accurate information.
- Scheduled patient appointments and managed authorization requests, ensuring timely and efficient access to healthcare services.
- Checked eligibility for a wide range of insurance plans, including HMO, PPO, POS, Medicare, and Medicaid.
- Overland Park, KS
- Fostered strong relationships with insurance providers to quickly resolve eligibility issues, improving overall workflow efficiency.
- Worked collaboratively with the billing department, helping to decrease claim rejection rates by 12% by streamlining the documentation process.
- Guided patients through the insurance verification process, offering clear explanations of benefits and coverage.
Customer Service Representative
DST
Kansas City, USA
01.2017 - 08.2017
- Responded to incoming calls from clients regarding investment accounts, retirement plans, and college savings plans, delivering accurate and clear information in a timely manner.
- Assisted clients in setting up new accounts, providing guidance on necessary steps and required documentation.
- Addressed client concerns and resolved issues, ensuring all inquiries were handled with professionalism and courtesy.
- Kansas City, MO
- Developed a reputation for building strong client relationships, leading to increased repeat business and referrals.
- Consistently met and exceeded performance targets, achieving top-ranking customer service scores within the team.
- Helped improve internal processes by identifying common issues clients faced and suggesting effective solutions.
Customer Service Representative
UPS Supply Chain Services
Overland Park, USA
10.2014 - 10.2016
- Responded to customer inquiries regarding inventory, delivery status, and freight-related issues, ensuring a positive experience.
- Invoiced commercial clients, ensuring all charges were accurately recorded and payments were processed in a timely manner.
- Overland Park, KS
- Developed a system for tracking and reporting lost freight that was later adopted company-wide due to its effectiveness.
- Reduced response time for customer inquiries by 20% through the implementation of streamlined reporting processes.
- Consistently maintained a professional and helpful demeanor during high-pressure calls, leading to a high volume of repeat clients and positive feedback.
Document Specialist
IRS
Kansas City, USA
01.2014 - 12.2014
- Identified and rectified any errors in tax documentation, ensuring corrections were made promptly to avoid delays.
- Utilized expert knowledge of tax codes to update and correct tax documents, ensuring proper classification and compliance.
- Kansas City, MO
- Improved the overall accuracy of tax return documentation by implementing a more thorough review process.
- Reduced processing time by 20% by streamlining the documentation review process and implementing a more efficient workflow.
- Built strong relationships with clients, providing excellent service and timely responses to document-related queries.
Customer Service Representative
Tyco Integrated Security
Kansas City, Missouri
04.2012 - 12.2013
- Assisted customers with alarm system troubleshooting and escalated technical issues to field technicians when needed.
- Coordinated dispatch of police, fire, and medical units for alarm signals.
- Addressed inbound calls, emails, and chats with professionalism, maintaining high level of customer service.
- Updated customer account information and processed changes promptly.
Executed account upgrades and cancellations to streamline operations.
Customer Service Representative
Ceva Logistics
Kansas City, Missouri
01.2009 - 06.2010
- Oversee shipment tracking and tracing, ensuring timely communication of delays to customers.
- Maintained customer accounts by entering orders and ensuring timely updates to shipment systems.
- Maintain accurate documentation and ensure compliance with company policies and customer requirements.
- Assisted with billing questions, documentation, and administrative support as needed.
- Facilitated coordination between operations, warehouse, and transportation teams to guarantee on-time delivery and efficient logistics processes.
Education
High School Diploma -
Kelloggsville High School
Wyoming, MI05.2005
Skills
- Case management and claims processing
- Authorization and insurance verification
- Patient data entry and documentation accuracy
- Healthcare regulations and medical terminology
- Workflow optimization and process improvement
- Cross-functional collaboration and communication skills
- Problem-solving and critical thinking
- Customer service and patient interaction
- Data analysis and quality assurance
- Time management and multitasking
- Appointment scheduling and patient privacy protection
- EHR management and healthcare systems navigation
- Patient payment processing and insurance billing
- Insurance claims follow-up
- Patient education and support
- Empathy and active listening
- Call center operations
Timeline
Customer Service Representative
Evry Health
06.2025 - Current
Case Manager Processor
Molina Health Care
05.2023 - Current
Customer Service Rep
L.A. Care Health Plan
09.2022 - 05.2023
Patient Quality Specialist
Apria Healthcare
01.2018 - 08.2022
Customer Service Representative
DST
01.2017 - 08.2017
Customer Service Representative
UPS Supply Chain Services
10.2014 - 10.2016
Document Specialist
IRS
01.2014 - 12.2014
Customer Service Representative
Tyco Integrated Security
04.2012 - 12.2013
Customer Service Representative
Ceva Logistics
01.2009 - 06.2010
High School Diploma -
Kelloggsville High School